Anticoagulant management is one of the clearest sources of a skilled Part A day, because the therapy requires ongoing skilled monitoring and judgment: warfarin with INR-based dose adjustment, direct oral anticoagulants with renal and bleeding surveillance, and heparin/LMWH. The skilled work is bleeding surveillance, the interpretation of the INR and adjustment within the ordered protocol, the recognition of supratherapeutic anticoagulation and the need for reversal, and the coordination of the narrow therapeutic window.
This overlay proves, for each billed day it applies, that skilled anticoagulation observation, a covered procedure, management and evaluation, or teaching was reasonable, necessary, needed daily, and available only in a SNF under Pub. 100-02 Chapter 8. Use it with the reference for the underlying condition (AF → Cardiovascular; DVT → Peripheral Vascular; GI bleed → Gastrointestinal) and Falls.
