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
Perfusion not assessed
‘Pulses present’ without perfusion detail or comparison reads as non-skilled.
Document pulses, perfusion, and limb comparison and the reason observation was skilled. (ADR.)
Compression without adequacy check
Compression applied without confirming arterial supply.
Confirm arterial adequacy, document tolerance and the edema effect.
DVT surveillance thin
At-risk resident with no limb assessment.
Document the DVT surveillance (swelling, warmth, calf comparison) each shift.
MDS ulcer unsupported
Section M vascular ulcer coded without the assessment.
Carry the vascular-ulcer assessment in the note (route detail to Skin). (F641.)
