Acute Blood loss anemia

We have the worst time getting providers to state "blood loss" with their documented "acute on chronic anemia" - transfusing PRBCs for Hgb of 6.9 but without heme+ stools/melena, hematochezia, etc. If they do not see overt blood loss they clinically do not equate the term "blood loss" to the acute anemia. I'm referring to general scenarios where there is no evidence of a contributing iron deficiency or the anemia not d/t chemo/cancer etc.

In the coding world we seem to only be able to capture the severity/acuity of the condition w/the D62 code. Any suggestions as to how a query can be re-worded to get the needed documentation or how any CDI programs have successfully educated their providers in this regard? We do not have a physician advisor to help.

Thank you!



  • Honestly, if there is no indication of blood loss, what is your underlying evidence to suggest that as an option? Without supportive evidence (even if there is no quantifiable amount of loss, at least indication of loss), I would be concerned from a compliance perspective.

    Perhaps could ask an open ended query for the etiology of the acute anemia...

  • When the patient has been transfused w/PRBCs, a drop in Hgb of 2g, they are symptomatic - hypotensive, lightheaded, or syncopal and they're monitoring the lab trends, consulting GI - all the things - I should've included more details.

  • That is a rather convincing set of clinical criteria!! :)

    The best idea I can offer is if you are able to engage in conversation with providers (or better medical directors), come from the perspective of a typical patient with clinical setting of ... can you share your thought process of the likely etiology? Understanding & acknowledge that there is no overt blood loss...

    If the provider is willing to verbalize, or if you have the chance to suggest that there was an etiology including occult blood loss, might be able to get the connection and their understanding that they can express their clinical opinion of the likely etiology.

    Difficult situation certainly


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