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
Limb not measured/assessed
‘Swollen, compression on’ without measurement or surveillance.
Document the measurement, compression/skin care, and cellulitis surveillance. (ADR.)
Cellulitis not escalated
Limb erythema not recognized/escalated.
Recognize and escalate cellulitis in a lymphedematous limb early.
Limb protection absent
At-risk limb without documented protection.
Document limb protection (no BP/venipuncture).
MDS diagnosis unsupported
Section I/M coded without the note.
Carry the limb assessment and care in the note. (F641.)
