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
No post-surgical assessment
Activity logged without a surgical-site/complication assessment.
Document the incision, drain, prophylaxis, and complication surveillance each shift. (ADR.)
Prophylaxis not tracked
VTE prophylaxis coded but not shown/monitored.
Document the prophylaxis administration and calf assessment. (F641.)
Rehab-nursing not documented
Carryover assumed, not shown with an RN evaluation.
Document the rehabilitation-nursing delivery and RN evaluation. (Route to Restorative.)
