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
‘O₂ on, no distress’ without values/target reads as non-skilled.
Document SpO₂ against the ordered target and the reason observation was skilled. (ADR.)
Oxygen target not documented
Oxygen coded without the target range and response.
Chart the oxygen setting, SpO₂, and target-range titration. (F641.)
Teaching without mastery
Inhaler ‘education’ without a return-demo.
Document the return-demonstration and action-plan teach-back.
Exacerbation surveillance thin
No sputum/effort trend on a COPD stay.
Document sputum and work-of-breathing trend each shift.
