Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
Error message
MDS Lookup
Weight Loss
Item Rationale
Matrix review
7 matrix group(s) are already attached for review on this item.
Answer coverage
3 governed answer row(s) are attached for this item.
Answer Codes
Code 0
No or unknown
if the resident has not experienced weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days or if information abo...
Code 1
Yes on physician-prescribed weight-loss regimen
if the resident has experienced a weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days, and the weight loss wa...
Code 2
Yes, not on physician-prescribed weight-loss regimen
if the resident has experienced a weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days, and the weight loss wa...
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section K and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page K-4
- CMS exact locator: Manual page K-4
- This item has 3 governed answer row(s) attached.
Source awareness
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Source & Review
Manual
CMS MDS 3.0 RAI Manual v1.20.1
Status
Published
Effective start
2025-10-01
Item locator
Manual page K-4
CMS exact locator
Manual page K-4
Full CMS Text
Item Rationale
Health-related Quality of Life
Weight loss can result in debility and adversely affect health, safety, and quality of life. For persons with morbid obesity, controlled and careful weight loss can improve mobility and health status. For persons with a large volume (fluid) overload, controlled and careful diuresis can improve health status.
Planning for Care
Weight loss may be an important indicator of a change in the resident’s health status or environment. If significant weight loss is noted, the interdisciplinary team should review for possible causes of changed intake, changed caloric need, change in medication (e.g., diuretics), or changed fluid volume status. Weight should be monitored on a continuing basis; weight loss should be assessed and care planned at the time of detection and not delayed until the next MDS assessment.
DEFINITIONS
5% WEIGHT LOSS IN 30 DAYS Start with the resident’s weight closest to 30 days ago and multiply it by .95 (or 95%). The resulting figure represents a 5% loss from the weight 30 days ago. If the resident’s current weight is equal to or less than the resulting figure, the resident has lost more than 5% body weight. 10% WEIGHT LOSS IN 180 DAYS Start with the resident’s weight closest to 180 days ago and multiply it by .90 (or 90%). The resulting figure represents a 10% loss from the weight 180 days ago. If the resident’s current weight is equal to or less than the resulting figure, the resident has lost 10% or more body weight.
Steps for Assessment
This item compares the resident’s weight in the current observation period with their weight at two snapshots in time: At a point closest to 30 days preceding the current weight. At a point closest to 180 days preceding the current weight. The resident’s weight captured closest to these two time points are the only two weights considered for this item, but the resident’s weight should be monitored on a continual basis and weight loss assessed and addressed on the care plan as necessary. For a New Admission 1. Ask the resident, family, or significant other about weight loss over the past 30 and 180 days.
2. Consult the resident’s physician, review transfer
documentation, and compare with admission weight.
3. If the admission weight is less than the previous weight,
calculate the percentage of weight loss.
4. Complete the same process to determine and calculate
weight loss comparing the admission weight to the weight 30 and 180 days ago. For Subsequent Assessments 1. From the medical record, compare the resident’s weight in the current observation period to their weight in the observation period 30 days ago.
2. If the current weight is less than the weight in the
observation period 30 days ago, calculate the percentage of weight loss.
3. From the medical record, compare the resident’s weight in
the current observation period to their weight in the observation period 180 days ago.
4. If the current weight is less than the weight in the
observation period 180 days ago, calculate the percentage of weight loss. Weight Comparison Examples *Weight as determined in item K0200B. Based on an ARD of 10/15/25.
DEFINITIONS
PHYSICIAN- PRESCRIBED WEIGHT- LOSS REGIMEN A weight reduction plan ordered by the resident’s physician with the care plan goal of weight reduction. May employ a calorie-restricted diet or other weight loss diets and exercise. Also includes planned diuresis. It is important that weight loss is intentional. BODY MASS INDEX (BMI) Number calculated from a person’s weight and height. BMI is used as a screening tool to identify possible weight problems for adults. Visit https://www.cdc.gov/bmi/faq/.
Coding Instructions
Mathematically round weights as described in Section K0200B before completing the weight loss calculation.
Code 0, no or unknown: if the resident has not experienced weight loss of 5% or
more in the past 30 days or 10% or more in the last 180 days or if information about prior weight is not available.
Code 1, yes on physician-prescribed weight-loss regimen: if the resident
has experienced a weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days, and the weight loss was planned and pursuant to a physician’s order. In cases where a resident has a weight loss of 5% or more in 30 days or 10% or more in 180 days as a result of any physician ordered diet plan or expected weight loss due to loss of fluid with physician orders for diuretics, K0300 can be coded as 1.
Code 2, yes, not on physician-prescribed weight-loss regimen: if the
resident has experienced a weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days, and the weight loss was not planned and prescribed by a physician.
Coding Tips
A resident may experience weight variances in between the snapshot time periods. Although these require follow up at the time, they are not captured on the MDS. In cases in which multiple weights for the resident may exist during the time period being evaluated, select the weight on the date closest to the appropriate time point. If the resident is losing a significant amount of weight, the facility should not wait for the 30- or 180-day timeframe to address the problem. Weight changes of 5% in 1 month, 7.5% in 3 months, or 10% in 6 months should prompt a thorough assessment of the resident’s nutritional status. To code K0300 as 1, yes, the expressed goal of the weight loss diet or the expected weight loss of edema through the use of diuretics must be documented. On occasion, a resident with normal BMI or even low BMI is placed on a diabetic or otherwise calorie-restricted diet. In this instance, the intent of the diet is not to induce weight loss, and it would not be considered a physician-ordered weight-loss regimen.
Examples
1. Resident J has been on a physician ordered calorie-restricted diet for the past year. They and
their physician agreed to a plan of weight reduction. Their current weight is 169 lbs. Their weight 30 days ago was 172 lbs. Their weight 180 days ago was 192 lbs.
Coding: K0300 would be coded 1, yes, on physician-prescribed weight-
loss regimen.
Rationale:
30-day calculation: 172 x 0.95 = 163.4. Since the resident’s current weight of 169 lbs is more than 163.4 lbs, which is the 5% point, they have not lost 5% body weight in the last 30 days. 180-day calculation: 192 x .90 = 172.8. Since the resident’s current weight of 169 lbs is less than 172.8 lbs, which is the 10% point, they have lost 10% or more of body weight in the last 180 days.
2. Resident S has had increasing need for assistance with eating over the past 6 months. Their
current weight is 195 lbs. Their weight 30 days ago was 197 lbs. Their weight 180 days ago was 185 lbs.
Coding: K0300 would be coded 0, No.
Rationale:
30-day calculation: 197 x 0.95 = 187.15. Because the resident’s current weight of 195 lbs is more than 187.15 lbs, which is the 5% point, they have not lost 5% body weight in the last 30 days. 180-day calculation: Resident S’s current weight of 195 lbs is greater than their weight 180 days ago, so there is no need to calculate their weight loss. They have gained weight over this time period.
3. Resident K underwent a BKA (below the knee amputation). Their preoperative weight 30
days ago was 130 lbs. Their most recent postoperative weight is 102 lbs. The amputated leg weighed 8 lbs. Their weight 180 days ago was 125 lbs. Was the change in weight significant? Calculation of change in weight must take into account the weight of the amputated limb (which in this case is 6% of 130 lbs = 7.8 lbs). 30-day calculation: Step 1: Add the weight of the amputated limb to the current weight to obtain the weight if no amputation occurred: 102 lbs (current weight) + 8 lbs (weight of leg) = 110 lbs (current body weight taking the amputated leg into account) Step 2: Calculate the difference between the most recent weight (including weight of the limb) and the previous weight (at 30 days) 130 lbs (preoperative weight) - 110 lbs (present weight if had two legs) = 20 lbs (weight lost) Step 3: Calculate the percent weight change relative to the initial weight: 20 lbs (weight change) /130 lbs (preoperative weight) = 15% weight loss Step 4: The percent weight change is significant if >5% at 30 days Therefore, the most recent postoperative weight of 102 lbs (110 lbs, taking the amputated limb into account) is >5% weight loss (significant at 30 days). 180-day calculation: Step 1: Add the weight of the amputated limb to the current weight to obtain the weight if no amputation occurred: 102 lbs (current weight) + 8 lbs (weight of leg) = 110 lbs (current body weight taking the amputated leg into account) Step 2: Calculate the difference between the most recent weight (including weight of the limb) and the previous weight (at 180 days): 125 lbs (preoperative weight 180 days ago) - 110 lbs (present weight if had two legs) = 15 lbs (weight lost) Step 3: Calculate the percent weight change relative to the initial weight: 15 lbs (weight change) / 130 lbs (preoperative weight) = 12% weight loss Step 4: The percent weight change is significant if >10% at 180 days The most recent postoperative weight of 110 lbs (110 lbs, taking the amputated limb into account) is >10% weight loss (significant at 180 days). Present weight of 110 lbs >10% weight loss (significant at 180 days).
Coding: K0300 would be coded 2, yes, weight change is significant; not on
physician-prescribed weight-loss regimen.
Rationale: The resident had a significant weight loss of >5% in 30 days and did have a
weight loss of >10% in 180 days, the item would be coded as 2, yes weight change is significant; not on physician-prescribed weight–loss regime, with one of the items being triggered. This item is coded for either a 5% 30-day weight loss or a 10% 180-day weight loss. In this example both items, the criteria are met but the coding does not change as long as one of them are met.
Matrix Applicability
Nursing Home Subsets
NC - Comprehensive
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NQ - Quarterly
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
ND - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
Care Area Triggers
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NHQI Quality Measures
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
PDPM
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Swing Bed Subsets
SP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
SD - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Shared NH/SB Subsets
IPA - Interim Payment
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Discharge A=99, B=99, F=10, 11, G=1, 2, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
D/C Items (Only when A0310F = 10 or 11)
A0310G=1 PDC
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
A0310G=2 UPD
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Item Subset Required Use ISC Skip Patterns
PDPM (A0310B = 01 or 08)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4