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
Head assessment not paired with neuro
Incision noted without the neuro exam that makes it skilled.
Pair the head/incision assessment with the neuro exam and rationale. (ADR.)
Post-head-injury surveillance thin
A head strike without protocol neuro checks/delayed-bleed watch.
Document the scalp survey, protocol neuro checks, and the delayed-bleed watch.
Incision surveillance thin
Post-craniotomy incision with no complication screen.
Document incision findings and infection/CSF-leak surveillance each shift.
MDS diagnosis unsupported
Section I neurosurgery coded without the note.
Carry the post-surgical head assessment in the note. (F641.)
