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
Regimen under-documented
‘Drops given’ without the regimen, technique, or eye findings.
Document the ophthalmic regimen, technique, and operative-eye assessment each administration. (ADR.)
Positioning not documented
A required post-op positioning order not shown as enforced.
Document the positioning order, enforcement, and tolerance.
Complication surveillance thin
Post-op eye with no complication screen.
Document pain/redness/discharge/vision surveillance each shift.
Section B unsupported
Vision coded without the assessment in the note.
Carry the vision status and eye care in the note. (F641.)
