Extended criteria (experimental).
This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects
for CDI staff. The primary surface is Before you sign (kidney, measurement only).
All extended pages.
← Back to the worklist · Whole encounter ENC-00020
Florian Thorne: Acute blood loss anaemia
ENC-00020 · 50M · Cardiology · admitted Mon Nov 02, 2026 11:23 AM · discharged Thu Nov 05, 2026 04:44 PM · attending Dr. Jalen Carrow · resident Dr. Greta Kowalczyk
Specificity gap Criteria met Open
Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.
Documented vs supported
- Documented
- not documented
- Criteria support
- Acute blood loss anemia · D62 Acute posthemorrhagic anemia
- Outcome
- Haemoglobin fell 3.5 g/dL to 9.5 with 2 unit(s) transfused and a documented bleeding source
- Rule
- Acute blood loss anaemia v2026.11-1
- Published source
- WHO guideline on haemoglobin cutoffs to define anaemia in individuals and populations (2024), Adult cut-offs: men <13 g/dL, non-pregnant women <12 g/dL (unchanged from 2011) · source (checked 2026-11-14)
- Contested
- There is no published clinical definition of "acute blood loss anaemia". This rule is a LOCAL CONVENTION: WHO anaemia threshold at the nadir, a documented bleeding source, and an acute fall of >=2 g/dL OR >=2 units transfused (borrowed from the ISTH major-bleeding definition, which secondary restatements word inconsistently as AND/OR).
Effect if the clinician agrees (illustrative)
- Change
- add D62
- Secondary-diagnosis level
- — → CC
- MS-DRG (illustrative)
- 292 Heart failure and shock with CC → 292 Heart failure and shock with CC
- Relative weight
- 0.8490 → 0.8490 (+0.0000)
- Codes before
- I50.31, E66.812, N18.32, N17.9, E78.5
- Codes after
- I50.31, E66.812, N18.32, N17.9, E78.5, D62
All open gaps on this encounter together: MS-DRG 292 → 292 (RW +0.0000). The grouping does not change; the record becomes accurate.
CC/MCC status, CC exclusions (subset) and relative weights from the public CMS FY2026 IPPS final rule tables (5, 6I, 6J, 6K). This is not a grouper and not a payment estimate. Queries never mention any of this.
Severity documentation index change SIMULATED
0.5 points
SIMULATED: Illustrative severity weights (MCC = 1.0, CC = 0.5, non-CC = 0) summed over secondary diagnoses; not a validated risk-adjustment model and not a measured effect.
Evidence
Structured values are read by code from the cited rows. Note facts are shown only when the model's quote was found verbatim in the note.
| Input | Value | Source |
|---|---|---|
| Sex | M |
sex M
|
| First haemoglobin this stay (g/dL) | 12.99 |
hemoglobin 12.99 g/dL (first)
|
| Lowest haemoglobin this stay (g/dL) | 9.54 |
hemoglobin 9.54 g/dL (lowest)
|
| Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir |
3.5 |
hemoglobin 12.99
hemoglobin 9.54
|
| Red cell units transfused | 2 |
transfuse 2 unit(s) PRBC
|
| A bleeding source quoted from a note, or a bleeding principal diagnosis | True |
“black tarry stools”
Show the quote in the note… rdiology Attending: Dr. Jalen Carrow
History of present illness: 50-year-old man admitted with acute diastolic heart failure. Hospital course complicated by black tarry stools.
Past medical history: hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. … |
Rule trace (inputs, thresholds, outcome)
| Step | Expression | Inputs and thresholds read | Result |
|---|---|---|---|
| derived: anaemic | case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null) |
hgb_nadir=9.54, sex=M, t.hb_f=12, t.hb_m=13 | true |
| derived: acute_fall | hgb_drop >= t.drop_major or prbc_units >= t.prbc_major |
hgb_drop=3.5, prbc_units=2, t.drop_major=2.0, t.prbc_major=2 | true |
| outcome: met | bleeding_documented and anaemic and acute_fall |
acute_fall=True, anaemic=True, bleeding_documented=True | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #1993); clinical indicators and answer options assembled by code from the rule and the record.
Sign in to act. Sign in as a demo user (a CDI specialist sends queries).
DOCUMENTATION QUERY (draft) Title: Clarification request: hematology documentation Encounter: ENC-00020 Patient: Florian Thorne To: Dr. Jalen Carrow Clinical indicators from the health record: - sex M [encounter ENC-00020] - hemoglobin 12.99 g/dL (first) (2026-11-02 12:23) [lab LAB-000679] - hemoglobin 9.54 g/dL (lowest) (2026-11-04 05:00) [lab LAB-000681] - transfuse 2 unit(s) PRBC (2026-11-03 09:00) [order ORD-000016] - "black tarry stools" (2026-11-02 14:23) [History and physical DOC-000065, p. 1, line 5] Question: Based on your clinical judgement and the indicators above, can the type or cause of the condition being monitored and treated be further specified? Response options (select one or write your own): ( ) Acute blood loss anemia ( ) Anemia, type not further specified ( ) 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.
Other findings on this encounter
- Acute kidney injury · Clinical validation gap Documented “acute kidney injury” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 1993 | 2026-11-14T20:57:23 | system:llm system |
llm.call |
ENC-00020, ENC-00020.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry c74ce82b1c61 |
| 1167 | 2026-11-14T19:24:28 | system:llm system |
llm.call |
ENC-00020, ENC-00020.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 22c828115910 |
| 425 | 2026-11-14T18:29:03 | system:llm system |
llm.call |
ENC-00020, ENC-00020.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry a77ce3f9a480 |