The domain’s common reasons a Part A skilled day is down-coded or denied on medical review (ADR), and the corrected pattern. The full catalog lives in Denial Patterns.
Risk
Why it fails
Corrected pattern
Reaction under-documented
‘Allergic reaction’ without severity/management.
Document the reaction severity, management, and response; escalate anaphylaxis. (ADR.)
Immunosuppressed surveillance thin
Immunosuppression without infection surveillance/precautions.
Document the infection surveillance and precautions and the blunted-response caution.
IVIG under-documented
IVIG ‘given’ without premedication/reaction monitoring.
Document the premedication, titration, and reaction monitoring.
Section O/N unsupported
Immunotherapy/isolation coded without the note.
Carry the administration/precautions in the note. (F641.)
