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-00065
Lena Upfield: Acute blood loss anaemia
ENC-00065 · 51M · Hospital Medicine · admitted Tue Nov 10, 2026 03:47 PM · in hospital · attending Dr. Rosalind Quillan · resident Dr. Camila Oyelaran
Specificity gap Criteria met Open
In hospital: concurrent review Resident note awaiting attending cosign
Documented “anemia” (D64.9); criteria support the more specific Acute blood loss anemia (D62).
Documented vs supported
- Documented
- “anemia” · D64.9 Anemia, unspecified
- Criteria support
- Acute blood loss anemia · D62 Acute posthemorrhagic anemia
- Outcome
- Haemoglobin fell 2.9 g/dL to 10.7 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
- D64.9 -> D62
- Secondary-diagnosis level
- non-CC → CC
- MS-DRG (illustrative)
- 193 Simple pneumonia and pleurisy with MCC → 193 Simple pneumonia and pleurisy with MCC
- Relative weight
- 1.3144 → 1.3144 (+0.0000)
- Codes before
- J18.9, E43, N18.9, I50.30, R09.02, D64.9
- Codes after
- J18.9, E43, N18.9, I50.30, R09.02, D62
All open gaps on this encounter together: MS-DRG 193 → 193 (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) | 13.57 |
hemoglobin 13.57 g/dL (first)
|
| Lowest haemoglobin this stay (g/dL) | 10.71 |
hemoglobin 10.71 g/dL (lowest)
|
| Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir |
2.9 |
hemoglobin 13.57
hemoglobin 10.71
|
| Red cell units transfused | 2 |
transfuse 2 unit(s) PRBC
|
| A bleeding source quoted from a note, or a bleeding principal diagnosis | True |
“bright red blood per rectum”
Show the quote in the note… dmitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by bright red blood per rectum.
Past medical history: heart failure with preserved ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no d … |
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=10.71, 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=2.9, 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 #2092); 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-00065 Patient: Lena Upfield To: Dr. Rosalind Quillan Clinical indicators from the health record: - Documented in the record: "anemia" [Progress note DOC-000226] - sex M [encounter ENC-00065] - hemoglobin 13.57 g/dL (first) (2026-11-10 16:47) [lab LAB-002199] - hemoglobin 10.71 g/dL (lowest) (2026-11-12 05:00) [lab LAB-002201] - transfuse 2 unit(s) PRBC (2026-11-11 09:00) [order ORD-000056] - "bright red blood per rectum" (2026-11-10 18:47) [History and physical DOC-000225, 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
- Chronic kidney disease · Specificity gap Documented “chronic kidney disease” (N18.9); criteria support the more specific Chronic kidney disease stage 4 (N18.4).
- Heart failure · Specificity gap Documented “diastolic heart failure” (I50.30); criteria support the more specific Acute on chronic diastolic (HFpEF) heart failure (I50.33).
- Hyponatraemia · Specificity gap Criteria support Hyponatraemia (moderate) (E87.1); no corresponding diagnosis is documented.
- Malnutrition · Clinical validation gap Documented “severe malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (chronic illness context), E44.0).
- Acute respiratory failure · Clinical judgement required Clinical judgement required: Hypoxaemia without a charted sign of respiratory distress.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2092 | 2026-11-14T20:57:24 | system:llm system |
llm.call |
ENC-00065, ENC-00065.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 4ac012186ecf |
| 1266 | 2026-11-14T19:24:29 | system:llm system |
llm.call |
ENC-00065, ENC-00065.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 392bb9c86316 |
| 524 | 2026-11-14T18:29:04 | system:llm system |
llm.call |
ENC-00065, ENC-00065.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry cad3f8e63a93 |