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
Task-only glucose/insulin
‘BS checked, insulin given’ without value/judgment reads as non-skilled.
Document the value vs the ordered range and the judgment applied. (ADR.)
No recheck after treatment
Hypo/hyperglycemia treated without a documented recheck.
Document the recheck value and symptom resolution.
Insulin day unsupported
Section N insulin coded without administration in the note.
Chart the insulin type/dose/site and response each shift. (F641.)
Complications off the record
Foot/renal risk not monitored on a diabetic stay.
Document foot and renal surveillance (route detail to Skin/Renal).
