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-00122
Bodhi Foxhall: Acute blood loss anaemia
ENC-00122 · 47M · Hospital Medicine · admitted Thu Nov 05, 2026 09:13 PM · discharged Mon Nov 09, 2026 10:39 AM · attending Dr. Kenji Stavros
Specificity gap Criteria met Open
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 2.7 g/dL to 10.6 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)
- 689 Kidney and urinary tract infections with MCC → 689 Kidney and urinary tract infections with MCC
- Relative weight
- 1.1603 → 1.1603 (+0.0000)
- Codes before
- N39.0, E43, N17.9, I50.9, J96.01, D64.9, E11.9, I10, K21.9
- Codes after
- N39.0, E43, N17.9, I50.9, J96.01, E11.9, I10, K21.9, D62
All open gaps on this encounter together: MS-DRG 689 → 689 (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) | 13.35 |
hemoglobin 13.35 g/dL (first)
|
| Lowest haemoglobin this stay (g/dL) | 10.61 |
hemoglobin 10.61 g/dL (lowest)
|
| Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir |
2.7 |
hemoglobin 13.35
hemoglobin 10.61
|
| 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… 7-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Hospital course complicated by bleeding from the surgical drain.
Past medical history: type 2 diabetes, hypertension, GERD.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscl … |
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=10.61, 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=2.7, 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 #2200); 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-00122 Patient: Bodhi Foxhall To: Dr. Kenji Stavros Clinical indicators from the health record: - Documented in the record: "anemia" [Progress note DOC-000413] - sex M [encounter ENC-00122] - hemoglobin 13.35 g/dL (first) (2026-11-05 22:13) [lab LAB-004152] - hemoglobin 10.61 g/dL (lowest) (2026-11-07 05:00) [lab LAB-004154] - transfuse 2 unit(s) PRBC (2026-11-06 09:00) [order ORD-000103] - "bleeding from the surgical drain" (2026-11-06 00:13) [History and physical DOC-000412, 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 “AKI” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.
- Heart failure · Specificity gap Documented “heart failure” (I50.9); criteria support the more specific Acute systolic (HFrEF) heart failure (I50.21).
- Malnutrition · Clinical validation gap Documented “severe malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2200 | 2026-11-14T20:57:25 | system:llm system |
llm.call |
ENC-00122, ENC-00122.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 750f2c5e9606 |
| 1374 | 2026-11-14T19:24:30 | system:llm system |
llm.call |
ENC-00122, ENC-00122.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry 38d6ac99fbbe |
| 632 | 2026-11-14T18:29:06 | system:llm system |
llm.call |
ENC-00122, ENC-00122.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 6be16a7af78b output bfa18fc1e32e entry bfb6f4f36d0b |