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
INR/monitoring not documented
Warfarin ‘given’ without the INR/target/decision reads as non-skilled.
Document the INR against the target and the protocol-based dose decision. (ADR.)
Bleeding surveillance thin
‘No bleeding’ without specifics.
Document the specific bleeding surveillance each shift.
Supratherapeutic not managed
A high INR noted without a protocol action.
Hold per protocol, notify, order the recheck, and monitor.
Anticoagulant day unsupported
Section N coded without administration/monitoring.
Carry the anticoagulant administration and monitoring in the note. (F641.)
