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
No post-surgical assessment
The note logs activity but shows no surgical-site/neurovascular assessment.
Document the incision, neurovascular status, and precautions each shift. (ADR.)
Rehab-nursing not documented
Carryover assumed, not shown with an RN evaluation.
Document the rehabilitation-nursing delivery and RN evaluation. (F641; route to Restorative.)
Prophylaxis not tracked
VTE prophylaxis coded but not shown administered/monitored.
Chart the prophylaxis administration and calf assessment. (F641.)
Cloned post-op notes
Identical daily language gives no trajectory.
Re-document the actual surgical course and change since the prior day.
