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
Task-only GI charting
‘Abdomen soft, ostomy intact’ without assessment reads as non-skilled.
Document the GI/stoma assessment and the reason observation was skilled. (ADR.)
Bleed surveillance thin
GI-bleed recovery with no stool/vital trend.
Chart stool characteristics and the vital-sign trend each shift.
Ostomy item unsupported
Section H ostomy coded without care/assessment in the note.
Document the stoma/peristomal assessment and care. (F641.)
Isolation not documented
C. difficile isolation coded but not shown.
Chart the precautions and the active infection requiring them. (Section O.)
