Query for acute blood loss anemia

rania.fahmy@jefferson.edurania.fahmy@jefferson.edu
in Clinical & Coding
Hello, 
how many lab values for Hgb and Hct are needed to submit a compliant query? Are 2 post op labs for H and H enough?
Also, if no treatment given (iron or blood transfusion) but H and H are trending down and below normal values.. should I query?

Comments

  • drew.siegel205drew.siegel205
    Only one value would be necessary if the patient receives treatment such as PRBC or there is a contributing diagnosis such as advanced CKD or ESRD. 
    Treatment of the 'anemia' is not required. It isf the Hb is being monitored (repeated labs, iron studies, etc) then it meets criteria for a secondary diagnosis and a query would be in order. 
  • nzd1980nzd1980
    We have this issue with the coding department that they will not take any query for Drop in HH, clinical presentation is NSVD and a drop in Hgb from 13.5 to 10 that was monitored but not treated and pt had some tachycardia. Would you query for the significance of this drop?
  • drew.siegel205drew.siegel205
    The Hb is being monitored and I get the impression that you think the tachycardia may be related to the lower hemoglobin. In that case, I would query for significance. 
  • sarthakthanawalasarthakthanawala
    We rolled out education to the team to query if more than one H/H readings are present along with the overall clinical picture of acute anemia. Would love to hear what others are practicing. Thanks!
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited August 2019
    Monitoring alone can satisfy UHDDS criteria. 

    My Personal thoughts/criteria for one form of anemia - acute blood loss:

    1.  How much blood is estimated to have been lost/recorded, intraoperatively by MD, and during recovery by RN staff via drains, dressing?  What does your staff consider to be a ‘significant’ loss of blood?  300 cc - 500cc?  
    2.  If surgery was planned, what are the H/H values pre and post?  What is a ‘significant’ decline? Is is a certain % as defined by your program?
    3.  Obviously, transfusions make it easier to justify a query or coding, but some patients refuse.  Serial monitoring of labs can satisfy UHDDS criteria - also consider the RN Care Plan may be reviewed for evidence the patient is being monitored for syncope, increased pulse, and manifestations of anemia - satisfying one of the UHDDS reporting requirements.
    4.  Bear in mind the impact of dilution.  
    5.  Other factors....does the patient chronic anemia due to some other process, such as ESRD, nutritional deficiency, etc?
    6. Regarding #5 above,  think about referencing the RBC indices.  Anemia due to acute loss of blood is normocytic with a drop in Hb proportional to severity.
    7.  A picture of a patient that is hypochromic, microcytic, marcocytic (partial listing) can indicate other types of anemia may be present.

    Paul Evans, RHIA, CCDS
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited August 2019
    A normochromic, normocytic patient that has a documented (significant) loss of blood with a measurable decline in Hg associated with a loss of blood that satisfies any one of the UHDDS criteria may be a ‘classic’ case of anemia due to acute blood loss.

    Review chart for PMH or current history of any other forms of anemia...consider referencing CBC profiles so that clinician may evaluate other potential factors causing an anemia not associated with blood loss, or the existence of a (new) acute anemia due to loss of blood concurrent with anemia present and due to other factors, such as ESRD, nutritional deficiencies, etc.
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