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
Sensory deficit not managed
Neuropathy noted without protective management or inspection.
Document the sensory assessment, the skin/foot inspection, and the protective management. (ADR.)
Acute change not escalated
A new sensory change without an associated-sign screen.
Screen for weakness/bowel-bladder change and escalate an acute change.
Injury cause not addressed
An insensate injury without a protective-plan revision.
Identify the cause, treat, and revise the protective plan.
MDS diagnosis unsupported
Section GG/I coded without the sensory note.
Carry the sensory assessment and protection in the note. (F641.)
