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
Post-op surveillance thin
Incision noted without bleeding/dehiscence/VTE surveillance.
Document the vaginal bleeding, cuff-dehiscence, infection, and VTE surveillance. (ADR.)
Hemorrhage/dehiscence not recognized
Heavy bleeding/gush not escalated.
Recognize and escalate hemorrhage or cuff dehiscence urgently.
Pessary care thin
Pessary noted without fit/skin assessment.
Document the pessary fit, retention, and perineal skin.
MDS diagnosis unsupported
Section M/I coded without the note.
Carry the gynecologic/perineal assessment in the note. (F641.)
