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
Epistaxis under-assessed
‘Nosebleed’ without site/anticoagulation/hemodynamic detail.
Document the site, control, anticoagulation status, and bleeding surveillance. (ADR.)
Nares not assessed under a device
Cannula/NG noted without a nares assessment.
Document the nares condition and device care each shift.
CSF leak missed
Clear nasal drainage post-neurosurgery not escalated.
Recognize and escalate a possible CSF leak.
MDS diagnosis unsupported
Section I coded without the nasal assessment.
Carry the nasal assessment/care in the note. (F641.)
