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
Routine-check charting
‘Lungs clear, O₂ on’ without values or rationale reads as non-skilled.
Document values vs the ordered parameter and the reason daily observation was skilled. (ADR.)
Oxygen day unsupported
Section O oxygen coded without the setting/response in the note.
Chart the O₂ setting, SpO₂, and titration each shift. (F641.)
Cloned respiratory notes
Identical daily language gives no trajectory.
Re-document the actual findings and the change since the prior value.
Procedure without assessment
Suctioning/trach care logged as a task only.
Add secretion characteristics, airway assessment, and tolerance.
