P16 KE-P16 · inpatient visit

One row per condition family: what the record supports under the published definition, what the note states, the visit's diagnosis entries, and an assessment. Codes are coded from the signed documentation; the software never assigns one.

Library check LRUN-00016 · library_default_set@1.0 · library-engine 1.0 · replay df3873637fe81bb6… · Data (JSON)

Draft query: Hypoglycaemia (in people with diabetes)

Blocked by the query linter

A non-leading clarification request: clinical indicators with their sources, an open question, several options plus "other" and "unable to determine". No code and no payment word; the same indicators cannot be queried twice.

DOCUMENTATION QUERY (draft) for KE-P16 · hypoglycaemia
Title: Clarification request: glucose results
Encounter: KE-P16   Patient: P16   To: author of the draft note
From: (no named sender: sign in to send)
Date: 2026-11-13   Rule versions: ada2026_hypoglycaemia@1.0, library_default_set@1.0   Check run: LRUN-00016

Clinical indicators from the health record:
- Visit diagnosis list entry: "Hypoglycemia, unspecified" [visit diagnosis list LD-P16-1]
- Glucose 62 mg/dL (2026-11-12 06:00) [measurement LM-P16-04]

Question:
Based on your independent clinical judgement, can the documentation be further specified in light of the glucose results listed above?

Response options (select one or write your own):
( ) Hypoglycemia level 1
( ) Hypoglycemia level 2
( ) Hypoglycemia level 3
( ) Not clinically significant for this encounter
( ) Other (please specify): ____________
( ) Unable to determine

Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.

error · no_sender: A query needs a named human sender (sign in).

Condition families for this encounter (4)
Condition family	What the record supports	What the note states	Visit diagnosis entries	Assessment
Hypoglycaemia (in people with diabetes) measured	`ada2026_hypoglycaemia@1.0` Draft · pending review Level 1: glucose <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L) glucose plasma 62 mg/dL 2026-11-12 06:00 · LM-P16-04 Window: 14 days before the check. Citation Hypoglycaemia level (ADA Standards of Care 2026) ada2026_hypoglycaemia@1.0 Level 1: Glucose <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L). Level 2: Glucose <54 mg/dL (<3.0 mmol/L). Level 3: A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia American Diabetes Association Professional Practice Committee, 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026 (2026) · Table 6.4 Classification of hypoglycemia · source Contested: The International Hypoglycaemia Study Group (2017) sets level 1 at 'a glucose alert value of 3.9 mmol/l (70 mg/dl) or less', i.e. it includes exactly 70 mg/dL; ADA 2026 uses '<70'. CTCAE uses other cut-offs. Not encoded: Level 3 is clinical: it is reported only when the caller supplies severe_event_requiring_assistance = true; otherwise it is skipped with a note. Whether the glucose came from a meter, CGM or laboratory is not distinguished; CGM duration criteria (for example 15 minutes) are not stated in the opened table and are not encoded.	Not stated	`E16.2` Hypoglycemia, unspecified (visit diagnosis list (synthetic))	Supported, but entered or stated less specifically than the record supports entered E16.2 (Hypoglycemia, unspecified) The code family distinguishes: hypoglycaemia level 1, level 2, level 3 (E16.A1-E16.A3, new; not yet in the 2027 initial HCC file), drug-induced without coma, other, unspecified; in diabetes the combination codes E08-E13 with .64- are used. Draft a query
Code-family reference: Hypoglycaemia (in people with diabetes) Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `E16` Other disorders of pancreatic internal secretion: distinguishes hypoglycaemia level 1, level 2, level 3 (E16.A1-E16.A3, new; not yet in the 2027 initial HCC file), drug-induced without coma, other, unspecified; in diabetes the combination codes E08-E13 with .64- are used (10 codes in the category). `E16.0` Drug-induced hypoglycemia without coma `E16.1` Other hypoglycemia `E16.2` Hypoglycemia, unspecified `E16.3` Increased secretion of glucagon `E16.4` Increased secretion of gastrin `E16.8` Other specified disorders of pancreatic internal secretion `E16.9` Disorder of pancreatic internal secretion, unspecified `E16.A1` Hypoglycemia level 1 `E16.A2` Hypoglycemia level 2 `E16.A3` Hypoglycemia level 3 `E11` Type 2 diabetes mellitus: distinguishes type 2 diabetes with hypoglycaemia with or without coma (E11.64-) (87 codes in the category). 87 codes; see the official files Codes in this family for the category the record supports: `E16.A1` Hypoglycemia level 1. Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).
Diabetes mellitus measured	`ada2026_diabetes@1.0` Draft · pending review Diabetes criteria met: two abnormal results (different tests, or the same test at two times) hba1c 8.2 % 2026-09-12 09:00 · LM-P16-02 Window: 730 days before the check. Citation Diabetes diagnostic thresholds and the confirmation rule (ADA Standards of Care 2026) ada2026_diabetes@1.0 Table 2.1: A1C ≥6.5% (≥48 mmol/mol); FPG ≥126 mg/dL (≥7.0 mmol/L); 2-h PG ≥200 mg/dL (≥11.1 mmol/L) during OGTT; random plasma glucose ≥200 mg/dL (≥11.1 mmol/L) with classic symptoms of hyperglycemia or hyperglycemic crisis. In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal results from different tests ... or the same test at two different time points. American Diabetes Association Professional Practice Committee, 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026 (2026) · Table 2.1 Criteria for the diagnosis of diabetes in nonpregnant individuals · source Not encoded: Type of diabetes (type 1, type 2, other) is not assessed. Conditions that make A1C unreliable (some haemoglobin variants, pregnancy, G6PD deficiency, HIV, anaemia, haemodialysis, erythropoietin; recommendation 2.4 and text) are not checked: A1C results are used as sent. No maximum interval between the two abnormal results is stated by the source and none is applied. Whether the test method is NGSP-certified and whether a fasting sample was truly fasting are asserted by the sender through the analyte name. When two different tests are discordant ADA advises repeating the abnormal test; this entry simply reports one abnormal result.	diabetes	None entered	Supported and specific
Code-family reference: Diabetes mellitus Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `E11` Type 2 diabetes mellitus: distinguishes type 2 diabetes with or without complications by body system (kidney, eye, nerve, circulatory, skin, oral, hypoglycaemia, hyperglycaemia, ketoacidosis, hyperosmolarity), long-term drug use is separate (Z79) (87 codes in the category). 87 codes; see the official files `E10` Type 1 diabetes mellitus: distinguishes type 1 diabetes with the same complication axes as E11 (87 codes in the category). 87 codes; see the official files Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).
Hyperkalaemia measured	`ukka2026_hyperkalaemia@1.0` Draft · pending review Criteria not met: Below 5.5 mmol/L potassium serum 5.3 mmol/L 2026-11-12 07:00 · LM-P16-05 Window: 14 days before the check. Citation Hyperkalaemia and its severity (UK Kidney Association, July 2026 update) ukka2026_hyperkalaemia@1.0 It is further classified by severity into mild (5.5-5.9 mmol/l), moderate (6.0-6.4 mmol/l) or severe (≥ 6.5 mmol/l). UK Kidney Association, Clinical Practice Guidelines: Treatment of Acute Hyperkalaemia in Adults (2026) · Introduction, document page 9 (PDF page 10) · source Contested: The guideline itself says 'There is no universally accepted definition of hyperkalaemia'; it adopts the ERC threshold of 5.5 mmol/L. CTCAE grades differ (see ctcae6_hyperkalaemia). Not encoded: Pseudohyperkalaemia (guideline 15.3: haemolysis, delayed analysis, sampling technique) is not detected; a haemolysed sample is graded like any other unless the sender withholds it. Acute versus chronic (persistent) hyperkalaemia and the guideline's repeat-testing intervals (guidelines 1.2.1-1.2.3) are not encoded. ECG changes and clinical context are not assessed.	Not stated	None entered	Nothing to act on
Code-family reference: Hyperkalaemia Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `E87` Other disorders of fluid, electrolyte and acid-base balance: distinguishes E87.5 hyperkalemia (one code; no severity axis) (14 codes in the category). `E87.0` Hyperosmolality and hypernatremia `E87.1` Hypo-osmolality and hyponatremia `E87.20` Acidosis, unspecified `E87.21` Acute metabolic acidosis `E87.22` Chronic metabolic acidosis `E87.29` Other acidosis `E87.3` Alkalosis `E87.4` Mixed disorder of acid-base balance `E87.5` Hyperkalemia `E87.6` Hypokalemia `E87.70` Fluid overload, unspecified `E87.71` Transfusion associated circulatory overload `E87.79` Other fluid overload `E87.8` Other disorders of electrolyte and fluid balance, not elsewhere classified Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).
Prediabetes measured	`ada2026_prediabetes@1.0` Draft · pending review Criteria not met: A result is in the diabetes range — prediabetes not assigned; see ada2026_diabetes hba1c 8.2 % 2026-09-12 09:00 · LM-P16-02 Window: 365 days before the check. Citation Prediabetes ranges (ADA Standards of Care 2026) ada2026_prediabetes@1.0 A1C 5.7–6.4% (39–47 mmol/mol); FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG); 2-h PG during 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT) American Diabetes Association Professional Practice Committee, 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026 (2026) · Table 2.2 Criteria defining prediabetes in nonpregnant individuals · source Contested: Other bodies (for example WHO) are understood to use a different impaired fasting glucose range and not to use an A1C prediabetes range; those texts were not opened, so no other thresholds are recorded. Review item. Not encoded: ADA does not require confirmation for prediabetes in Table 2.2; none is applied. A1C reliability conditions are not checked (see ada2026_diabetes). Only the most recent result of each test is used.	Not stated	None entered	Nothing to act on
Code-family reference: Prediabetes Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `R73` Elevated blood glucose level: distinguishes R73.01 impaired fasting glucose, R73.02 impaired glucose tolerance (oral), R73.03 prediabetes, R73.09 other abnormal glucose, R73.9 hyperglycaemia unspecified (5 codes in the category). `R73.01` Impaired fasting glucose `R73.02` Impaired glucose tolerance (oral) `R73.03` Prediabetes `R73.09` Other abnormal glucose `R73.9` Hyperglycemia, unspecified Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).