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
Under-documented IV procedure
‘IV given, site intact’ omits the elements that prove a skilled procedure.
Document the route, site assessment, flush, and response each administration. (ADR.)
Drain output not trended
Drain noted without a volume/character trend.
Chart the output volume/character and site each shift.
IV item unsupported
Section O IV coded without administration in the note.
Document the IV medication administration and monitoring. (F641.)
Complication not escalated
A site change noted without action.
Hold, assess, escalate, and document the closed loop.
