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-00039
Sana Pemberton: Acute blood loss anaemia
ENC-00039 · 67F · Cardiology · admitted Mon Nov 09, 2026 04:36 PM · in hospital · attending Dr. Wes Merriweather · resident Dr. Keira Upfield
Specificity gap Criteria met Open
In hospital: concurrent review Resident note awaiting attending cosign
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 3.2 g/dL to 9 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
- I50.33, E46, E78.5
- Codes after
- I50.33, E46, E78.5, D62
All open gaps on this encounter together: MS-DRG 292 → 291 (RW +0.4348).
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 | F |
sex F
|
| First haemoglobin this stay (g/dL) | 12.13 |
hemoglobin 12.13 g/dL (first)
|
| Lowest haemoglobin this stay (g/dL) | 8.98 |
hemoglobin 8.98 g/dL (lowest)
|
| Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir |
3.2 |
hemoglobin 12.13
hemoglobin 8.98
|
| Red cell units transfused | 2 |
transfuse 2 unit(s) PRBC
|
| A bleeding source quoted from a note, or a bleeding principal diagnosis | True |
“bleeding from the surgical drain”
Show the quote in the note… ing: Dr. Wes Merriweather
History of present illness: 67-year-old woman admitted with acute on chronic diastolic heart failure. Hospital course complicated by bleeding from the surgical drain.
Past medical history: heart failure with preserved ejection fraction, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at … |
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=8.98, sex=F, 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=3.2, 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 #2029); clinical indicators and answer options assembled by code from the rule and the record.
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DOCUMENTATION QUERY (draft) Title: Clarification request: hematology documentation Encounter: ENC-00039 Patient: Sana Pemberton To: Dr. Wes Merriweather Clinical indicators from the health record: - sex F [encounter ENC-00039] - hemoglobin 12.13 g/dL (first) (2026-11-09 17:36) [lab LAB-001353] - hemoglobin 8.98 g/dL (lowest) (2026-11-11 05:00) [lab LAB-001355] - transfuse 2 unit(s) PRBC (2026-11-10 09:00) [order ORD-000032] - "bleeding from the surgical drain" (2026-11-09 19:36) [History and physical DOC-000131, 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
- Malnutrition · Clinical judgement required Clinical judgement required: Only one consensus characteristic documented; two are required.
- Pressure injury · Specificity gap Criteria support Pressure injury of sacral region, stage 4 (L89.154); no corresponding diagnosis is documented.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2029 | 2026-11-14T20:57:23 | system:llm system |
llm.call |
ENC-00039, ENC-00039.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 08f16d5b9fb0 |
| 1203 | 2026-11-14T19:24:28 | system:llm system |
llm.call |
ENC-00039, ENC-00039.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry ef14c075bff9 |
| 461 | 2026-11-14T18:29:03 | system:llm system |
llm.call |
ENC-00039, ENC-00039.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 8f3dc5b5afa8 |