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
Irrigation under-documented
‘CBI running’ without outflow/patency/clot surveillance.
Document the outflow color, patency, clot/distension surveillance, and output. (ADR.)
Hemorrhage not managed
Bright-red outflow/clots without hand-irrigation/escalation.
Hand-irrigate per protocol, escalate, and review anticoagulation.
Emergency not recognized
Severe scrotal pain or spreading infection not escalated.
Recognize and escalate torsion or Fournier gangrene urgently.
MDS diagnosis unsupported
Section H/M/I coded without the note.
Carry the urologic/genital assessment in the note. (F641.)
