diagnoses_ccs
diagnoses_ccs_19350368_21992333
source line 6025
User Question
<task_instruction> Your current task is to act as a diagnostician. Your objective is to determine all plausible diagnoses for the patient's current condition by analyzing the patient's complete history. You must find the most likely official CCS candidates using the **`diagnoses_ccs_candidates`** reference table. When you need medical knowledge or clinical information to support your diagnostic reasoning, use the `browser.search` tool to find authoritative medical information from reliable sources. Submit your final answer through `ehr.finish` as a **list** containing **multiple plausible diagnoses**. Each item in the list must be a string representing an official CCS diagnosis name, and **must not contain any codes or other additional information**. </task_instruction> <patient_info> Current Time: 2133-03-02 14:43:00 Patient Subject ID: 19350368 </patient_info>
Ground Truth (8)
- Other complications of birth; puerperium affecting management of mother
- Other complications of pregnancy
- Thyroid disorders
- Miscellaneous mental health disorders
- Mood disorders
- Other complications of pregnancy
- Esophageal disorders
- Other pregnancy and delivery including normal
Model Prediction (9)
- Other pregnancy and delivery including normal
- Deficiency and other anemia
- Thyroid disorders
- Mood disorders
- Disorders of lipid metabolism
- Late effects of cerebrovascular disease
- Esophageal disorders
- OB-related trauma to perineum and vulva
- Other complications of pregnancy
Step 1
Assistant Message
I'll start by loading the patient's EHR data and exploring the available tables.
ehr ehr.load_ehr
subject_id 19350368
timestamp 2133-03-02 14:43:00
Tool Response1,382 chars
Loading Candidate Tables: - Loading 'microbiologyevents_candidates' with 171 rows. - Loading 'radiology_candidates' with 963 rows. - Loading 'transfers_candidates' with 38 rows. - Loading 'diagnoses_ccs_candidates' with 87103 rows. - Loading 'procedures_ccs_candidates' with 83131 rows. - Loading 'labevents_candidates' with 1619 rows. - Loading 'prescriptions_atc_candidates' with 156201 rows. Loading EHR Tables: - Loading 'triage' with 3 rows. - Loading 'diagnosis' with 0 rows. - Loading 'edstays' with 0 rows. - Loading 'medrecon' with 0 rows. - Loading 'vitalsign' with 0 rows. - L…
Loading Candidate Tables: - Loading 'microbiologyevents_candidates' with 171 rows. - Loading 'radiology_candidates' with 963 rows. - Loading 'transfers_candidates' with 38 rows. - Loading 'diagnoses_ccs_candidates' with 87103 rows. - Loading 'procedures_ccs_candidates' with 83131 rows. - Loading 'labevents_candidates' with 1619 rows. - Loading 'prescriptions_atc_candidates' with 156201 rows. Loading EHR Tables: - Loading 'triage' with 3 rows. - Loading 'diagnosis' with 0 rows. - Loading 'edstays' with 0 rows. - Loading 'medrecon' with 0 rows. - Loading 'vitalsign' with 0 rows. - Loading 'services' with 1 rows. - Loading 'poe' with 44 rows. - Loading 'procedures_icd' with 1 rows. - Loading 'patients' with 1 rows. - Loading 'transfers' with 3 rows. - Loading 'labevents' with 75 rows. - Loading 'prescriptions' with 17 rows. - Loading 'omr' with 10 rows. - Loading 'emar_detail' with 102 rows. - Loading 'admissions' with 1 rows. - Loading 'diagnoses_icd' with 0 rows. - Loading 'hcpcsevents' with 0 rows. - Loading 'poe_detail' with 24 rows. - Loading 'pharmacy' with 16 rows. - Loading 'drgcodes' with 4 rows. - Loading 'microbiologyevents' with 10 rows. - Loading 'emar' with 0 rows. - Loading 'discharge' with 0 rows. - Loading 'radiology' with 5 rows. - Loading 'discharge_detail' with 1 rows. - Loading 'radiology_detail' with 54 rows.
ehr ehr.get_table_names
subject_id 19350368
Tool Response528 chars
Available Tables: EHR Tables: admissions, diagnoses_icd, diagnosis, discharge, discharge_detail, drgcodes, edstays, emar, emar_detail, hcpcsevents, labevents, medrecon, microbiologyevents, omr, patients, pharmacy, poe, poe_detail, prescriptions, procedures_icd, radiology, radiology_detail, services, transfers, triage, vitalsign Candidate Tables: diagnoses_ccs_candidates, labevents_candidates, microbiologyevents_candidates, prescriptions_atc_candidates, procedures_ccs_candidates, radiology_candidates, transfers_candidates
Step 2
ehr ehr.get_latest_records
subject_id 19350368
table_name admissions
Tool Response283 chars
subject_id hadm_id admittime admission_type admit_provider_id admission_location insurance language marital_status race edregtime 19350368 21992333 2133-02-28 14:25:00 URGENT P39CSL PHYSICIAN REFERRAL Other ENGLISH MARRIED WHITE nan
ehr ehr.get_latest_records
subject_id 19350368
table_name patients
Tool Response85 chars
Error: No timestamp column found in table 'patients'. Cannot find the latest records.
ehr ehr.get_latest_records
subject_id 19350368
table_name triage
Tool Response83 chars
Error: No timestamp column found in table 'triage'. Cannot find the latest records.
ehr ehr.get_latest_records
subject_id 19350368
table_name services
Tool Response131 chars
subject_id hadm_id transfertime prev_service curr_service 19350368 21992333 2133-02-28 14:39:49 nan OBS
ehr ehr.get_latest_records
subject_id 19350368
table_name drgcodes
Tool Response85 chars
Error: No timestamp column found in table 'drgcodes'. Cannot find the latest records.
Step 3
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM patients
Tool Response125 chars
subject_id gender anchor_age anchor_year anchor_year_group dod 19350368 F 44 2131 2011 - 2013 nan
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM triage
Tool Response459 chars
subject_id stay_id temperature heartrate resprate o2sat sbp dbp pain acuity chiefcomplaint 19350368 33696418 98.8 98.0 18.0 100.0 137.0 88.0 3 3.0 Abnormal labs, Dyspnea, R Arm pain 19350368 36913911 97.0 64.0 16.0 99.0 123.0 79.0 0 2.0 Dizziness 19350368 37118556 98.0 69.0 18.0 100.0 123.0 65.0 0 1.0 Weakness
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM drgcodes
Tool Response669 chars
subject_id hadm_id drg_type drg_code description drg_severity drg_mortality 19350368 21992333 APR 560 VAGINAL DELIVERY 1.0 1.0 19350368 21992333 HCFA 775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES nan nan 19350368 28053321 APR 45 CVA & PRECEREBRAL OCCLUSION W INFARCT 3.0 1.0 19350368 28053321 HCFA 65 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS nan nan
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM discharge_detail
Tool Response125 chars
note_id subject_id field_name field_value field_ordinal 19350368-DS-12 19350368 author ___ 1
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM transfers
Tool Response483 chars
subject_id hadm_id transfer_id eventtype careunit intime outtime 19350368 21992333.0 36688929 admit Labor & Delivery 2133-02-28 14:39:49 2133-02-28 17:46:31 19350368 21992333.0 38152498 transfer Obstetrics (Postpartum & Antepartum) 2133-02-28 17:46:31 2133-03-02 14:53:55 19350368 nan 34082153 ED Emergency Department 2131-07-22 08:53:00 2131-07-22 11:12:00
Step 4
ehr ehr.think
response
Key findings so far: - 46-year-old female (anchor_age 44 in 2131, current year 2133) - Current admission (hadm_id 21992333): Admitted 2133-02-28, urgent, physician referral - DRG codes for current admission: VAGINAL DELIVERY (APR 560, HCFA 775) - so this is a delivery admission - Transfers: Labor & Delivery then to Obstetrics Postpartum - Prior admission (hadm_id 28053321): CVA & PRECEREBRAL OCCLUSION W INFARCT - history of stroke - Triage records show past chief complaints: Abnormal labs/Dyspnea/R Arm pain, Dizziness, Weakness - Current time is 2133-03-02 14:43:00, patient is still in Obstetrics postpartum Let me look at more clinical details - labs, prescriptions, radiology, procedures, discharge notes.
Tool Response15 chars
Thinking Finish
Step 5
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM labevents ORDER BY charttime
Tool Response42,027 chars
labevent_id subject_id hadm_id specimen_id itemid order_provider_id charttime storetime value valuenum valueuom ref_range_lower ref_range_upper flag priority comments label fluid category 110521938 19350368 nan 10184475 …
labevent_id subject_id hadm_id specimen_id itemid order_provider_id charttime storetime value valuenum valueuom ref_range_lower ref_range_upper flag priority comments label fluid category 110521938 19350368 nan 10184475 50903 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 2.9 2.9 Ratio nan nan nan ROUTINE nan Cholesterol Ratio (Total/HDL) Blood Chemistry 110521939 19350368 nan 10184475 50904 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 83 83.0 mg/dL nan nan nan ROUTINE nan Cholesterol, HDL Blood Chemistry 110521940 19350368 nan 10184475 50905 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 135 135.0 mg/dL 0.0 129.0 abnormal ROUTINE nan Cholesterol, LDL, Calculated Blood Chemistry 110521941 19350368 nan 10184475 50907 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 238 238.0 mg/dL 0.0 199.0 abnormal ROUTINE nan Cholesterol, Total Blood Chemistry 110521942 19350368 nan 10184475 50993 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 1.8 1.8 uIU/mL 0.27 4.2 nan ROUTINE nan Thyroid Stimulating Hormone Blood Chemistry 110521943 19350368 nan 10184475 50995 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 1.2 1.2 ng/dL 0.93 1.7 nan ROUTINE nan Thyroxine (T4), Free Blood Chemistry 110521944 19350368 nan 10184475 51000 P71C9K 2130-10-17 17:15:00 2130-10-17 22:31:00 ___ 102.0 mg/dL 0.0 149.0 nan ROUTINE LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE. Triglycerides Blood Chemistry 110521945 19350368 nan 61742480 51463 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE MOD. Bacteria Urine Hematology 110521946 19350368 nan 61742480 51464 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan mg/dL nan nan nan ROUTINE NEG. Bilirubin Urine Hematology 110521947 19350368 nan 61742480 51466 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE SM . Blood Urine Hematology 110521948 19350368 nan 61742480 51469 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE FEW. Calcium Oxalate Crystals Urine Hematology 110521949 19350368 nan 61742480 51476 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 2 2.0 #/hpf nan nan nan ROUTINE nan Epithelial Cells Urine Hematology 110521950 19350368 nan 61742480 51478 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan mg/dL nan nan nan ROUTINE NEG. Glucose Urine Hematology 110521951 19350368 nan 61742480 51484 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan mg/dL nan nan nan ROUTINE NEG. Ketone Urine Hematology 110521952 19350368 nan 61742480 51486 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE NEG. Leukocytes Urine Hematology 110521953 19350368 nan 61742480 51487 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE NEG. Nitrite Urine Hematology 110521954 19350368 nan 61742480 51491 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 6.0 6.0 units 5.0 8.0 nan ROUTINE nan pH Urine Hematology 110521955 19350368 nan 61742480 51492 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan mg/dL nan nan nan ROUTINE TR. Protein Urine Hematology 110521956 19350368 nan 61742480 51493 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 9 9.0 #/hpf 0.0 2.0 abnormal ROUTINE nan RBC Urine Hematology 110521957 19350368 nan 61742480 51498 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 1.025 1.025 1.001 1.035 nan ROUTINE nan Specific Gravity Urine Hematology 110521958 19350368 nan 61742480 51506 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE Hazy. Urine Appearance Urine Hematology 110521959 19350368 nan 61742480 51508 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE Yellow. Urine Color Urine Hematology 110521960 19350368 nan 61742480 51512 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan nan nan nan nan ROUTINE RARE. Urine Mucous Urine Hematology 110521961 19350368 nan 61742480 51514 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 nan nan mg/dL 0.2 1.0 nan ROUTINE NEG. Urobilinogen Urine Hematology 110521962 19350368 nan 61742480 51516 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 1 1.0 #/hpf 0.0 5.0 nan ROUTINE nan WBC Urine Hematology 110521963 19350368 nan 61742480 51519 P889F8 2131-04-30 18:51:00 2131-04-30 22:40:00 NONE nan nan nan nan nan ROUTINE nan Yeast Urine Hematology 110521964 19350368 nan 12527694 50903 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 2.6 2.6 Ratio nan nan nan ROUTINE nan Cholesterol Ratio (Total/HDL) Blood Chemistry 110521965 19350368 nan 12527694 50904 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 91 91.0 mg/dL nan nan nan ROUTINE nan Cholesterol, HDL Blood Chemistry 110521966 19350368 nan 12527694 50905 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 132 132.0 mg/dL 0.0 129.0 abnormal ROUTINE nan Cholesterol, LDL, Calculated Blood Chemistry 110521967 19350368 nan 12527694 50907 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 238 238.0 mg/dL 0.0 199.0 abnormal ROUTINE nan Cholesterol, Total Blood Chemistry 110521968 19350368 nan 12527694 50993 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 1.7 1.7 uIU/mL 0.27 4.2 nan ROUTINE nan Thyroid Stimulating Hormone Blood Chemistry 110521969 19350368 nan 12527694 50995 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 1.1 1.1 ng/dL 0.93 1.7 nan ROUTINE nan Thyroxine (T4), Free Blood Chemistry 110521970 19350368 nan 12527694 51000 P71C9K 2131-12-18 15:51:00 2131-12-18 21:50:00 ___ 77.0 mg/dL 0.0 149.0 nan ROUTINE LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE. Triglycerides Blood Chemistry 110521971 19350368 nan 1776334 50868 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 12 12.0 mEq/L 8.0 20.0 nan STAT nan Anion Gap Blood Chemistry 110521972 19350368 nan 1776334 50882 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 25 25.0 mEq/L 22.0 32.0 nan STAT nan Bicarbonate Blood Chemistry 110521973 19350368 nan 1776334 50893 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 9.5 9.5 mg/dL 8.4 10.3 nan STAT nan Calcium, Total Blood Chemistry 110521974 19350368 nan 1776334 50902 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 102 102.0 mEq/L 96.0 108.0 nan STAT nan Chloride Blood Chemistry 110521975 19350368 nan 1776334 50912 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 0.8 0.8 mg/dL 0.4 1.1 nan STAT nan Creatinine Blood Chemistry 110521976 19350368 nan 1776334 50920 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 nan nan nan nan nan nan STAT Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. Estimated GFR (MDRD equation) Blood Chemistry 110521977 19350368 nan 1776334 50931 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 ___ 81.0 mg/dL 70.0 100.0 nan STAT IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES. Glucose Blood Chemistry 110521978 19350368 nan 1776334 50960 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 2.0 2.0 mg/dL 1.6 2.6 nan STAT nan Magnesium Blood Chemistry 110521979 19350368 nan 1776334 50970 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 3.9 3.9 mg/dL 2.7 4.5 nan STAT nan Phosphate Blood Chemistry 110521980 19350368 nan 1776334 50971 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 4.0 4.0 mEq/L 3.3 5.1 nan STAT nan Potassium Blood Chemistry 110521981 19350368 nan 1776334 50983 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 135 135.0 mEq/L 133.0 145.0 nan STAT nan Sodium Blood Chemistry 110521982 19350368 nan 1776334 51006 P93OSG 2132-08-13 10:39:00 2132-08-13 11:55:00 9 9.0 mg/dL 6.0 20.0 nan STAT nan Urea Nitrogen Blood Chemistry 110521983 19350368 nan 23925104 51221 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 37.0 37.0 % 36.0 48.0 nan STAT nan Hematocrit Blood Hematology 110521984 19350368 nan 23925104 51222 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 12.6 12.6 g/dL 12.0 16.0 nan STAT nan Hemoglobin Blood Hematology 110521985 19350368 nan 23925104 51248 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 29.9 29.9 pg 27.0 32.0 nan STAT nan MCH Blood Hematology 110521986 19350368 nan 23925104 51249 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 33.9 33.9 % 31.0 35.0 nan STAT nan MCHC Blood Hematology 110521987 19350368 nan 23925104 51250 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 88 88.0 fL 82.0 98.0 nan STAT nan MCV Blood Hematology 110521988 19350368 nan 23925104 51265 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 263 263.0 K/uL 150.0 440.0 nan STAT nan Platelet Count Blood Hematology 110521989 19350368 nan 23925104 51277 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 12.8 12.8 % 10.5 15.5 nan STAT nan RDW Blood Hematology 110521990 19350368 nan 23925104 51279 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 4.20 4.2 m/uL 4.2 5.4 nan STAT nan Red Blood Cells Blood Hematology 110521991 19350368 nan 23925104 51301 P93OSG 2132-08-13 10:39:00 2132-08-13 11:18:00 5.3 5.3 K/uL 4.0 11.0 nan STAT nan White Blood Cells Blood Hematology 110521992 19350368 nan 39759818 51464 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan mg/dL nan nan nan ROUTINE NEG. Bilirubin Urine Hematology 110521993 19350368 nan 39759818 51466 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan nan nan nan nan ROUTINE NEG. Blood Urine Hematology 110521994 19350368 nan 39759818 51478 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 300 300.0 mg/dL nan nan nan ROUTINE nan Glucose Urine Hematology 110521995 19350368 nan 39759818 51484 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan mg/dL nan nan nan ROUTINE NEG. Ketone Urine Hematology 110521996 19350368 nan 39759818 51486 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan nan nan nan nan ROUTINE NEG. Leukocytes Urine Hematology 110521997 19350368 nan 39759818 51487 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan nan nan nan nan ROUTINE NEG. Nitrite Urine Hematology 110521998 19350368 nan 39759818 51491 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 7.0 7.0 units 5.0 8.0 nan ROUTINE nan pH Urine Hematology 110521999 19350368 nan 39759818 51492 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan mg/dL nan nan nan ROUTINE NEG. Protein Urine Hematology 110522000 19350368 nan 39759818 51498 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 1.004 1.004 1.001 1.035 nan ROUTINE nan Specific Gravity Urine Hematology 110522001 19350368 nan 39759818 51506 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan nan nan nan nan ROUTINE Hazy. Urine Appearance Urine Hematology 110522002 19350368 nan 39759818 51508 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan nan nan nan nan ROUTINE Straw. Urine Color Urine Hematology 110522003 19350368 nan 39759818 51514 P88ESS 2132-08-13 11:39:00 2132-08-13 12:49:00 nan nan mg/dL 0.2 1.0 nan ROUTINE NEG. Urobilinogen Urine Hematology 110522004 19350368 21992333.0 6284747 51221 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 30.1 30.1 % 36.0 48.0 abnormal STAT nan Hematocrit Blood Hematology 110522005 19350368 21992333.0 6284747 51222 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 10.3 10.3 g/dL 12.0 16.0 abnormal STAT nan Hemoglobin Blood Hematology 110522006 19350368 21992333.0 6284747 51248 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 26.4 26.4 pg 27.0 32.0 abnormal STAT nan MCH Blood Hematology 110522007 19350368 21992333.0 6284747 51249 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 34.3 34.3 % 31.0 35.0 nan STAT nan MCHC Blood Hematology 110522008 19350368 21992333.0 6284747 51250 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 77 77.0 fL 82.0 98.0 abnormal STAT nan MCV Blood Hematology 110522009 19350368 21992333.0 6284747 51265 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 231 231.0 K/uL 150.0 440.0 nan STAT nan Platelet Count Blood Hematology 110522010 19350368 21992333.0 6284747 51277 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 14.9 14.9 % 10.5 15.5 nan STAT nan RDW Blood Hematology 110522011 19350368 21992333.0 6284747 51279 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 3.91 3.91 m/uL 4.2 5.4 abnormal STAT nan Red Blood Cells Blood Hematology 110522012 19350368 21992333.0 6284747 51301 nan 2133-02-28 14:41:00 2133-02-28 15:03:00 8.4 8.4 K/uL 4.0 11.0 nan STAT nan White Blood Cells Blood Hematology
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM prescriptions ORDER BY starttime
Tool Response7,739 chars
subject_id hadm_id pharmacy_id poe_id poe_seq order_provider_id starttime stoptime drug_type drug formulary_drug_cd gsn ndc prod_strength form_rx dose_val_rx dose_unit_rx form_val_disp form_unit_disp doses_per_24_hrs route long_drug_name atc_name 19350368 21992333 27619081 19350368-38 38.0 P43K1W 2133-02-28 10:00:00 2133-03-02 20:00:00 MAIN Sertraline SERT…
subject_id hadm_id pharmacy_id poe_id poe_seq order_provider_id starttime stoptime drug_type drug formulary_drug_cd gsn ndc prod_strength form_rx dose_val_rx dose_unit_rx form_val_disp form_unit_disp doses_per_24_hrs route long_drug_name atc_name 19350368 21992333 27619081 19350368-38 38.0 P43K1W 2133-02-28 10:00:00 2133-03-02 20:00:00 MAIN Sertraline SERT100 046228 00904586761 100mg Tablet nan 100 mg 1 TAB 1.0 PO/NG Sertraline 50 MG Oral Tablet sertraline 19350368 21992333 57833933 19350368-58 58.0 P43K1W 2133-02-28 10:00:00 2133-03-02 20:00:00 MAIN Levothyroxine Sodium LEVO50 006649 00074455211 50mcg Tablet nan 50 mcg 1 TAB 1.0 PO/NG levothyroxine sodium 0.05 MG Oral Tablet [Synthroid] levothyroxine sodium 19350368 21992333 13706763 19350368-49 49.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Codeine Sulfate CODE30 004186 00054815624 30mg Tab nan 30-60 mg 1-2 TAB nan PO Codeine sulfate 30 MG Oral Tablet codeine 19350368 21992333 14129476 19350368-50 50.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Acetaminophen APAP500 004490 00904198861 500mg Tablet nan 500-1000 mg 1-2 TAB nan PO Acetaminophen 500 MG Oral Tablet [Mapap] paracetamol, combinations excl. psycholeptics 19350368 21992333 17891491 19350368-57 57.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN traZODONE TRAZ100 046242 00904399161 100mg Tablet nan 100 mg 1 TAB nan PO/NG Trazodone Hydrochloride 100 MG Oral Tablet trazodone 19350368 21992333 20153965 19350368-53 53.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Dibucaine DIBU 007484 00168004631 30GM TUBE 1% nan 1 Appl 0.1 TUBE nan TP dibucaine 0.01 MG/MG Topical Ointment cinchocaine 19350368 21992333 40359870 19350368-47 47.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Oxycodone-Acetaminophen (5mg-325mg) PERC 004222 00406051262 5mg/325mg Tablet nan 1-2 TAB 1-2 TAB nan PO acetaminophen 325 MG / oxycodone hydrochloride 5 MG Oral Tablet oxycodone and paracetamol 19350368 21992333 40447785 19350368-48 48.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Ibuprofen IBUP600 008349 00904585461 600mg Tablet nan 600 mg 1 TAB nan PO ibuprofen 600 MG Oral Tablet ibuprofen 19350368 21992333 43172589 19350368-37 37.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 BASE 0.9% Sodium Chloride NS1000OXYT nan 00000000000 1000 mL Bag nan 1000 mL 1 BAG nan IV DRIP NaN NaN 19350368 21992333 43172589 19350368-37 37.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Oxytocin OXYT20/1000 058554 61553074004 20 Units / 1000 mL 0.9% Sodium Chloride nan 20 UNIT 1 BAG nan IV DRIP NaN NaN 19350368 21992333 46601079 19350368-59 59.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Pantoprazole PANT40 027462 00008084199 40mg Tablet nan 40 mg 1 TAB 1.0 PO pantoprazole 40 MG Delayed Release Oral Tablet [Protonix] pantoprazole 19350368 21992333 56442205 19350368-52 52.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Milk of Magnesia MOM30L 003026 00121043130 30mL UD Cup nan 30 mL 1 UDCUP nan PO magnesium hydroxide 80 MG/ML Oral Suspension magnesium hydroxide 19350368 21992333 77134259 19350368-55 55.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Calcium Carbonate CALC500 002689 66553000401 500mg Tablet nan 500 mg 1 TAB nan PO NaN NaN 19350368 21992333 78753361 19350368-54 54.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Simethicone SIME80 002821 00182864389 80mg Tablet nan 80 mg 1 TAB nan PO Simethicone 80 MG Chewable Tablet 19350368 21992333 90123187 19350368-46 46.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Docusate Sodium DOCU100 003009 00904224461 100mg Capsule nan 100 mg 1 CAP nan PO Docusate Sodium 100 MG Oral Capsule [DOK] docusate sodium 19350368 21992333 95124117 19350368-51 51.0 P43K1W 2133-02-28 18:00:00 2133-03-02 20:00:00 MAIN Bisacodyl BISA10R 002944 00574705050 10mg Suppository nan 10 mg 1 SUPP nan PR bisacodyl 10 MG Rectal Suppository bisacodyl 19350368 21992333 20117667 19350368-60 60.0 P43K1W 2133-02-28 20:00:00 2133-03-02 20:00:00 MAIN Ranitidine RANI150 011673 00904526161 150mg Tablet nan 150 mg 1 TAB 2.0 PO/NG Ranitidine 150 MG Oral Tablet ranitidine
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM radiology ORDER BY charttime
Tool Response4,433 chars
note_id subject_id hadm_id note_type note_seq charttime storetime …
note_id subject_id hadm_id note_type note_seq charttime storetime text 19350368-RR-38 19350368 nan RR 38 2131-02-05 12:44:00 2131-02-08 16:09:00 HISTORY: Screening. Baseline. Right implant and left-sided breast reduction.\n\nDIGITAL SCREENING MAMMOGRAM INTERPRETED WITH CAD: Two additional implant\ndisplacement views on the right were obtained. There is marked discrepancy of\nthe two breasts with the right breast being smaller and containing less\nglandular tissue. A right saline subpectoral implant is stable. No clustered\nmicrocalcifications, dominant mass or areas of unexpected architectural\ndistortion. Previous films are not available for comparison, but no change\nfrom exam dated ___ by report.\n\nIMPRESSION: No evidence of malignancy. BI-RADS 2 - benign findings.\n 19350368-RR-39 19350368 nan RR 39 2131-12-30 09:06:00 2131-12-30 09:48:00 INDICATION: Bilateral wrist pain, worse on the left.\n\nThree views of each wrist are obtained and interpreted without comparison. \nThere is no fracture or dislocation. Joint spaces are normal. Note is made\nof negative ulnar variance on the right. There are no radiopaque foreign\nbodies or soft tissue calcifications.\n 19350368-RR-40 19350368 nan RR 40 2132-03-18 08:55:00 2132-03-18 14:40:00 DIGITAL SCREENING MAMMOGRAM WITH ICAD\n\nINDICATION: Screening.\n\nRoutine and implant-displaced views were obtained.\n\nThere are scattered fibroglandular densities. There is a saline implant\nbehind the pectoralis in the right breast having much of the same appearance\nthat it did in mammography on ___. There are no suspicious masses or\ncalcifications. Post-reduction changes in the left breast are present.\n\nIMPRESSION:\n\nNo evidence of malignancy.\n\nBI-RADS 1 -- negative.\n 19350368-RR-41 19350368 nan RR 41 2132-08-24 08:45:00 2132-08-24 14:48:00 This is a transabdominal ___. A full timeout was performed. The patient had\nsigned an informed consent, and after sterile chloraprep of her abdomen, a\ntransabdominal ___ was performed. This was done under direct ultrasound\nguidance and clear visualization. The patient tolerated the procedure well,\nand post fetal heart rate was normal. The patient is O positive.\n\n 19350368-RR-42 19350368 nan RR 42 2132-08-24 08:45:00 2132-08-24 09:58:00 There is a single live intrauterine pregnancy with a crown-rump length of 54\nmm, which is measuring 12 weeks 1 day. The fetal heart rate was 155 beats per\nminute. There are normal, adnexa, uterus and no gross fetal abnormalities are\nnoted. The placenta is forming anteriorly.\n\n
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM procedures_icd
Tool Response203 chars
subject_id hadm_id seq_num chartdate icd_code icd_version long_title 19350368 21992333 1 2133-02-28 23:59:00 7359 9 Other manually assisted delivery
Step 6
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM radiology_detail
Tool Response4,674 chars
note_id subject_id field_name field_value field_ordinal 19350368-RR-38 19350368 exam_code C8931 1 19350368-RR-38 19350368 exam_code C899 2 19350368-RR-38 19350368 exam_name CAD SCREENING 2 19350368-RR-38 19350368 exam_name DIG SCREENING BILAT 1 19350368-RR-39 19350368 exam_code E151B 1 19350368-RR-39 19350368 exam_name WRIST(3 + VIEWS) BILAT 1 19350…
note_id subject_id field_name field_value field_ordinal 19350368-RR-38 19350368 exam_code C8931 1 19350368-RR-38 19350368 exam_code C899 2 19350368-RR-38 19350368 exam_name CAD SCREENING 2 19350368-RR-38 19350368 exam_name DIG SCREENING BILAT 1 19350368-RR-39 19350368 exam_code E151B 1 19350368-RR-39 19350368 exam_name WRIST(3 + VIEWS) BILAT 1 19350368-RR-40 19350368 exam_code C8931 1 19350368-RR-40 19350368 exam_name DIG SCREENING WITH CAD MAMMOGRAM 1 19350368-RR-41 19350368 exam_code U4623 1 19350368-RR-41 19350368 exam_code U864 2 19350368-RR-41 19350368 exam_name ___ 1 19350368-RR-41 19350368 exam_name ___ 2 19350368-RR-42 19350368 exam_code U497 1 19350368-RR-42 19350368 exam_name ___ 1 19350368-RR-43 19350368 exam_code C8931 1 19350368-RR-43 19350368 exam_name DIG SCREENING WITH CAD MAMMOGRAM 1 19350368-RR-46 19350368 exam_code E161R 1 19350368-RR-46 19350368 exam_name HAND (AP, LAT & OBLIQUE) RIGHT 1 19350368-RR-47 19350368 exam_code C8935 1 19350368-RR-47 19350368 exam_name H DIGITAL SCREENING W/CAD 1 19350368-RR-48 19350368 exam_code C11 1 19350368-RR-48 19350368 exam_name CHEST (PA & LAT) 1 19350368-RR-50 19350368 exam_code C8931 1 19350368-RR-50 19350368 exam_name DIG SCREENING WITH CAD MAMMOGRAM 1 19350368-RR-51 19350368 exam_code Q1213 1 19350368-RR-51 19350368 exam_code Q25 2 19350368-RR-51 19350368 exam_name CTA HEAD W&W/O C & RECONS 1 19350368-RR-51 19350368 exam_name CTA NECK W&W/OC & RECONS 2 19350368-RR-52 19350368 exam_code T9112 1 19350368-RR-52 19350368 exam_name MR HEAD W & W/O CONTRAST 1 19350368-RR-53 19350368 exam_code T9412 1 19350368-RR-53 19350368 exam_code T9422 2 19350368-RR-53 19350368 exam_code T9432 3 19350368-RR-53 19350368 exam_name MR C-SPINE SCAN WITH CONTRAST 1 19350368-RR-53 19350368 exam_name MR L SPINE WITH CONTRAST 3 19350368-RR-53 19350368 exam_name MR T SPINE SCAN WITH CONTRAST 2 19350368-RR-54 19350368 exam_code U614 1 19350368-RR-54 19350368 exam_name BILAT LOWER EXT VEINS 1 19350368-RR-55 19350368 exam_code N8 1 19350368-RR-55 19350368 exam_name LUMBAR PUNCTURE (W/ FLUORO) 1 19350368-RR-60 19350368 exam_code Q416 1 19350368-RR-60 19350368 exam_name CTA CHEST 1 19350368-RR-61 19350368 exam_code C8931 1 19350368-RR-61 19350368 exam_name DIG SCREENING WITH CAD MAMMOGRAM 1 19350368-RR-62 19350368 exam_code Q4432 1 19350368-RR-62 19350368 exam_name CT ABD & PELVIS WITH CONTRAST 1 19350368-RR-64 19350368 exam_code C11 1 19350368-RR-64 19350368 exam_name CHEST (PA & LAT) 1 19350368-RR-65 19350368 exam_code T9112 1 19350368-RR-65 19350368 exam_name MR HEAD W & W/O CONTRAST 1 19350368-RR-66 19350368 exam_code C11 1 19350368-RR-66 19350368 exam_name CHEST (PA & LAT) 1 19350368-RR-67 19350368 exam_code C8943 1 19350368-RR-67 19350368 exam_name H DIGITAL SCREEN/TOMO,CVIEW & CAD 1
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM poe ORDER BY order_time
Tool Response112 chars
SQL Execution Error: Execution failed on sql 'SELECT * FROM poe ORDER BY order_time': no such column: order_time
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM microbiologyevents ORDER BY charttime
Tool Response4,628 chars
microevent_id subject_id hadm_id micro_specimen_id order_provider_id chartdate charttime spec_itemid spec_type_desc test_seq storedate storetime test_itemid test_name org_itemid org_name isolate_num quantity ab_itemid ab_name dilution_text dilution_comparison dilution_value interpretation comments
3011244 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 1 2132-09-03 00:00:00 …microevent_id subject_id hadm_id micro_specimen_id order_provider_id chartdate charttime spec_itemid spec_type_desc test_seq storedate storetime test_itemid test_name org_itemid org_name isolate_num quantity ab_itemid ab_name dilution_text dilution_comparison dilution_value interpretation comments
3011244 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 1 2132-09-03 00:00:00 nan 90071 CHROMOSOME ANALYSIS-CVS nan nan nan nan nan nan nan nan nan nan nan
3011245 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 2 2132-09-03 00:00:00 nan 90164 INTERPHASE FISH ANALYSIS, 100-300 CELLS nan nan nan nan nan nan nan nan nan nan ___
3011246 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 3 2132-09-03 00:00:00 nan 90150 MOLECULAR CYTOGENETICS - DNA PROBE nan nan nan nan nan nan nan nan nan nan ___
3011247 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 4 2132-09-03 00:00:00 nan 90150 MOLECULAR CYTOGENETICS - DNA PROBE nan nan nan nan nan nan nan nan nan nan ___
3011248 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 5 2132-09-03 00:00:00 nan 90150 MOLECULAR CYTOGENETICS - DNA PROBE nan nan nan nan nan nan nan nan nan nan ___
3011249 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 6 2132-09-03 00:00:00 nan 90150 MOLECULAR CYTOGENETICS - DNA PROBE nan nan nan nan nan nan nan nan nan nan ___
3011250 19350368 nan 6820967 P590NO 2132-08-24 2132-08-24 09:11:00 90909 CHORIONIC VILLUS SAMPLE 7 2132-09-03 00:00:00 nan 90150 MOLECULAR CYTOGENETICS - DNA PROBE nan nan nan nan nan nan nan nan nan nan ___
3011241 19350368 nan 5242820 P184W3 2130-10-30 nan 70002 THROAT FOR STREP 1 2130-10-31 00:00:00 2130-10-31 08:11:00 90130 R/O Beta Strep Group A 80054.0 BETA STREPTOCOCCUS GROUP A 1.0 nan nan nan nan nan nan nan nan
3011242 19350368 nan 2433209 P43JB2 2131-04-30 nan 70079 URINE 1 2131-05-01 00:00:00 2131-05-01 19:31:00 90039 URINE CULTURE nan nan nan nan nan nan nan nan nan nan NO GROWTH.
3011243 19350368 nan 8712577 P90TVI 2131-06-26 nan 70002 THROAT FOR STREP 1 2131-06-28 00:00:00 2131-06-28 15:10:00 90130 R/O Beta Strep Group A 80213.0 BETA STREPTOCOCCI, NOT GROUP A 1.0 nan nan nan nan nan nan nan NO BETA STREPTOCOCCUS GROUP A FOUND.Step 7
ehr ehr.get_column_names
subject_id 19350368
table_name poe
Tool Response197 chars
Columns for table 'poe': poe_id, poe_seq, subject_id, hadm_id, ordertime, order_type, order_subtype, transaction_type, discontinue_of_poe_id, discontinued_by_poe_id, order_provider_id, order_status
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM omr
Tool Response736 chars
subject_id chartdate seq_num result_name result_value 19350368 2130-10-17 23:59:00 1 Blood Pressure 110/60 19350368 2130-10-17 23:59:00 1 BMI (kg/m2) 26.6 19350368 2130-10-17 23:59:00 1 Weight (Lbs) 170 19350368 2130-10-30 23:59:00 1 Blood Pressure 110/64 19350368 2131-04-30 23:59:00 1 Blood Pressure 110/72 19350368 2131-06-26 23:59:00 1 Blood Pressure 118/72 19350368 2131-12-18 23:59:00 1 Blood Pressure 110/66 19350368 2131-12-18 23:59:00 1 BMI (kg/m2) 24.9 19350368 2131-12-18 23:59:00 1 Weight (Lbs) 159 19350368 2132-05-18 23:59:00 1 Blood Pressure 132/66
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM poe_detail
Tool Response1,799 chars
poe_id poe_seq subject_id field_name field_value 19350368-108 108 19350368 Admit category Place in observation 19350368-108 108 19350368 Admit to Neuromed 19350368-125 125 19350368 Admit category Admit to inpatient 19350368-125 125 19350368 Admit to Neuromed 19350368-140 140 19350368 Discharge Planning Finalized 19350368-141 141 19350368 Discharge When Discharge Now 19350368-144 144 19350368 Admit category Admit to inpatient 19350368-144 144 1…
poe_id poe_seq subject_id field_name field_value 19350368-108 108 19350368 Admit category Place in observation 19350368-108 108 19350368 Admit to Neuromed 19350368-125 125 19350368 Admit category Admit to inpatient 19350368-125 125 19350368 Admit to Neuromed 19350368-140 140 19350368 Discharge Planning Finalized 19350368-141 141 19350368 Discharge When Discharge Now 19350368-144 144 19350368 Admit category Admit to inpatient 19350368-144 144 19350368 Discharge Planning Finalized 19350368-145 145 19350368 Admit category Admit to inpatient 19350368-145 145 19350368 Discharge When Discharge Now 19350368-158 158 19350368 Admit category Admit to inpatient 19350368-158 158 19350368 Admit to Cardiology NP 19350368-183 183 19350368 Admit category Admit to inpatient 19350368-183 183 19350368 Admit to Cardiology NP 19350368-184 184 19350368 Discharge Planning Finalized 19350368-185 185 19350368 Discharge When Discharge Now 19350368-23 23 19350368 Admit category Admit to inpatient 19350368-23 23 19350368 Admit to Obstetrics 19350368-36 36 19350368 Admit category Admit to inpatient 19350368-36 36 19350368 Transfer to Obstetrics 19350368-61 61 19350368 Discharge Planning Finalized 19350368-62 62 19350368 Discharge When Discharge Now 19350368-94 94 19350368 Admit category Place in observation 19350368-94 94 19350368 Admit to Neuromed
Step 8
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM poe ORDER BY ordertime
Tool Response8,279 chars
poe_id poe_seq subject_id hadm_id ordertime order_type order_subtype transaction_type discontinue_of_poe_id discontinued_by_poe_id order_provider_id order_status 19350368-19 19 19350368 21992333 2133-02-28 13:50:33 General Care Other New nan nan P43K1W Inactive 19350368-20 20 19350368 21992333 2133-02-28 13:50:33 General Care Vitals/Monitoring New nan nan P43K1W Inactive 19350368-21 21 19350368 21992333 2133-02-…
poe_id poe_seq subject_id hadm_id ordertime order_type order_subtype transaction_type discontinue_of_poe_id discontinued_by_poe_id order_provider_id order_status 19350368-19 19 19350368 21992333 2133-02-28 13:50:33 General Care Other New nan nan P43K1W Inactive 19350368-20 20 19350368 21992333 2133-02-28 13:50:33 General Care Vitals/Monitoring New nan nan P43K1W Inactive 19350368-21 21 19350368 21992333 2133-02-28 13:50:33 General Care Other New nan nan P43K1W Inactive 19350368-22 22 19350368 21992333 2133-02-28 13:50:33 General Care Other New nan nan P43K1W Inactive 19350368-23 23 19350368 21992333 2133-02-28 14:39:28 ADT orders Admit New nan nan P52EIU Inactive 19350368-24 24 19350368 21992333 2133-02-28 14:39:28 General Care Vitals/Monitoring New nan nan P52EIU Inactive 19350368-25 25 19350368 21992333 2133-02-28 14:39:28 OB Fetal monitoring New nan nan P52EIU Inactive 19350368-26 26 19350368 21992333 2133-02-28 14:39:28 Nutrition Diet Order New nan nan P52EIU Inactive 19350368-27 27 19350368 21992333 2133-02-28 14:39:28 IV therapy IV access New nan nan P52EIU Inactive 19350368-28 28 19350368 21992333 2133-02-28 14:39:28 Medications nan New nan nan P52EIU Inactive 19350368-29 29 19350368 21992333 2133-02-28 14:39:28 IV therapy IV fluids New nan nan P52EIU Inactive 19350368-30 30 19350368 21992333 2133-02-28 14:39:28 Medications nan New nan nan P52EIU Inactive 19350368-31 31 19350368 21992333 2133-02-28 14:39:28 Medications nan New nan nan P52EIU Inactive 19350368-32 32 19350368 21992333 2133-02-28 14:39:28 Medications nan New nan nan P52EIU Inactive 19350368-33 33 19350368 21992333 2133-02-28 14:39:28 Medications nan New nan nan P52EIU Inactive 19350368-34 34 19350368 21992333 2133-02-28 14:47:20 Blood Bank Blood tests New nan nan P43K1W Inactive 19350368-35 35 19350368 21992333 2133-02-28 14:47:20 Lab nan New nan nan P43K1W Inactive 19350368-36 36 19350368 21992333 2133-02-28 17:50:29 ADT orders Transfer New nan nan P43K1W Inactive 19350368-37 37 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-38 38 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-39 39 19350368 21992333 2133-02-28 17:50:29 IV therapy IV access New nan nan P43K1W Inactive 19350368-40 40 19350368 21992333 2133-02-28 17:50:29 General Care Vitals/Monitoring New nan nan P43K1W Inactive 19350368-41 41 19350368 21992333 2133-02-28 17:50:29 General Care Activity New nan nan P43K1W Inactive 19350368-42 42 19350368 21992333 2133-02-28 17:50:29 Nutrition Diet Order New nan nan P43K1W Inactive 19350368-43 43 19350368 21992333 2133-02-28 17:50:29 General Care Other New nan nan P43K1W Inactive 19350368-44 44 19350368 21992333 2133-02-28 17:50:29 General Care Other New nan nan P43K1W Inactive 19350368-45 45 19350368 21992333 2133-02-28 17:50:29 General Care Other New nan nan P43K1W Inactive 19350368-46 46 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-47 47 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-48 48 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-49 49 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-50 50 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-51 51 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-52 52 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-53 53 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-54 54 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-55 55 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-56 56 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-57 57 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-58 58 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-59 59 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-60 60 19350368 21992333 2133-02-28 17:50:29 Medications nan New nan nan P43K1W Inactive 19350368-61 61 19350368 21992333 2133-03-02 08:08:03 ADT orders Discharge New nan nan P39CSL Inactive 19350368-62 62 19350368 21992333 2133-03-02 08:08:03 ADT orders Discharge New nan nan P39CSL Inactive
Step 9
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM emar_detail ORDER BY charttime
Tool Response118 chars
SQL Execution Error: Execution failed on sql 'SELECT * FROM emar_detail ORDER BY charttime': no such column: charttime
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM pharmacy
Tool Response52 chars
Query executed successfully but returned no results.
Step 10
ehr ehr.get_column_names
subject_id 19350368
table_name emar_detail
Tool Response647 chars
Columns for table 'emar_detail': subject_id, emar_id, emar_seq, parent_field_ordinal, administration_type, pharmacy_id, barcode_type, reason_for_no_barcode, complete_dose_not_given, dose_due, dose_due_unit, dose_given, dose_given_unit, will_remainder_of_dose_be_given, product_amount_given, product_unit, product_code, product_description, product_description_other, prior_infusion_rate, infusion_rate, infusion_rate_adjustment, infusion_rate_adjustment_amount, infusion_rate_unit, route, infusion_complete, completion_interval, new_iv_bag_hung, continued_infusion_in_other_location, restart_interval, side, site, non_formulary_visual_verification
Step 11
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT DISTINCT product_description, dose_given, dose_given_unit, route FROM emar_detail WHERE dose_given IS NOT NULL
Tool Response1,899 chars
product_description dose_given dose_given_unit route
Sodium Chloride 0.9% - Floor Stock Bag 1000 mL nan
nan nan nan nan
nan 1000 mL nan
Ibuprofen 400mg Tablet 400 mg nan
Sodium Chloride 0.9% Flush 3 mL nan
Omeprazole 20mg DR Capsule 20 mg nan
Sertraline 100mg Tablet 100 m… product_description dose_given dose_given_unit route
Sodium Chloride 0.9% - Floor Stock Bag 1000 mL nan
nan nan nan nan
nan 1000 mL nan
Ibuprofen 400mg Tablet 400 mg nan
Sodium Chloride 0.9% Flush 3 mL nan
Omeprazole 20mg DR Capsule 20 mg nan
Sertraline 100mg Tablet 100 mg nan
nan nan nan PO
TraZODone 100mg Tablet 100 mg nan
LORazepam 0.5mg Tablet 0.5 mg nan
Levothyroxine Sodium 75mcg Tab 75 mcg nan
Aspirin 81mg Tab 81 mg nan
LORazepam 1mg Tablet 1 mg nan
Lorazepam 2mg/mL Syringe 1 mg nan
Lidocaine 1% PF 2mL Amp 2 mL nan
Atorvastatin 80 mg nan
Levothyroxine Sodium 50mcg Tablet 50 mcg nan
nan 81 mg nan
Pantoprazole 40mg Tablet 40 mg nan
Acetaminophen 325mg Tablet 325 mg nan
Sertraline 50mg Tablet 50 mg nan
CefazoLIN 1 g / 50 mL Iso-Osmotic Dextrose 1 g nan
Docusate Sodium 100mg Capsule 100 mg nan
Clopidogrel 75 mg Tablet 75 mg nan ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM discharge WHERE hadm_id = 21992333
Tool Response52 chars
Query executed successfully but returned no results.
Step 12
ehr ehr.think
response
Important findings from emar_detail - the patient has been given various medications across multiple admissions. Notably: - Aspirin, Clopidogrel, Atorvastatin - anti-platelet and statin therapy, consistent with history of stroke/CVA - Lorazepam - anxiolytic - Omeprazole/Pantoprazole - GI/GERD - Sertraline, Trazodone - antidepressants/sleep aids - Levothyroxine - hypothyroidism - CefaZOLIN - antibiotic (peripartum prophylaxis?) - Oxytocin - labor/delivery Current admission summary: - 46-year-old female admitted 2133-02-28 for vaginal delivery (DRG: vaginal delivery without complications) - Procedure: Other manually assisted delivery (ICD 7359) - Lab work from admission shows: low hemoglobin (10.3 g/dL), low hematocrit (30.1%), low MCV (77 fL), low MCH (26.4 pg), low RBCs (3.91) - consistent with iron deficiency anemia or anemia of pregnancy - Medications include: oxytocin (labor induction/postpartum), pain medications (codeine, oxycodone-acetaminophen, ibuprofen), sertraline, levothyroxine, trazodone, pantoprazole, ranitidine - Postpartum in Obstetrics unit Medical history: - History of CVA/cerebral infarction (DRG code from prior admission hadm_id 28053321) - History of elevated cholesterol (LDL 132-135, Total 238) - On levothyroxine - hypothyroidism - On sertraline - depression - Breast implant (right) and left-sided breast reduction - Had CVS (chorionic villus sampling) in August 2132 - prenatal testing at 12 weeks - Had wrist X-rays for bilateral wrist pain in Dec 2131 Now I need to look at the discharge_detail table more carefully for the discharge summary of this admission. Let me also check if there are other admissions' records I should review.
Tool Response15 chars
Thinking Finish
Step 13
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT note_id, subject_id, hadm_id, note_type, note_seq, charttime, text FROM discharge_detail
Tool Response167 chars
SQL Execution Error: Execution failed on sql 'SELECT note_id, subject_id, hadm_id, note_type, note_seq, charttime, text FROM discharge_detail': no such column: hadm_id
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM admissions
Tool Response283 chars
subject_id hadm_id admittime admission_type admit_provider_id admission_location insurance language marital_status race edregtime 19350368 21992333 2133-02-28 14:25:00 URGENT P39CSL PHYSICIAN REFERRAL Other ENGLISH MARRIED WHITE nan
Step 14
ehr ehr.get_column_names
subject_id 19350368
table_name discharge_detail
Tool Response97 chars
Columns for table 'discharge_detail': note_id, subject_id, field_name, field_value, field_ordinal
Step 15
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT * FROM discharge_detail
Tool Response125 chars
note_id subject_id field_name field_value field_ordinal 19350368-DS-12 19350368 author ___ 1
Step 16
Assistant Message
The discharge note only has the author field. Let me check the discharge table directly.
ehr ehr.get_column_names
subject_id 19350368
table_name discharge
Tool Response108 chars
Columns for table 'discharge': note_id, subject_id, hadm_id, note_type, note_seq, charttime, storetime, text
Step 17
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT note_id, subject_id, hadm_id, note_type, note_seq, charttime, storetime, text FROM discharge
Tool Response52 chars
Query executed successfully but returned no results.
Step 18
Assistant Message
No discharge summary yet (patient hasn't been discharged). Let me check for any existing radiology text for the current admission period.
ehr ehr.run_sql_query
subject_id 19350368
sql_query SELECT note_id, charttime, text FROM radiology ORDER BY charttime
Tool Response4,085 chars
note_id charttime …
note_id charttime text 19350368-RR-38 2131-02-05 12:44:00 HISTORY: Screening. Baseline. Right implant and left-sided breast reduction.\n\nDIGITAL SCREENING MAMMOGRAM INTERPRETED WITH CAD: Two additional implant\ndisplacement views on the right were obtained. There is marked discrepancy of\nthe two breasts with the right breast being smaller and containing less\nglandular tissue. A right saline subpectoral implant is stable. No clustered\nmicrocalcifications, dominant mass or areas of unexpected architectural\ndistortion. Previous films are not available for comparison, but no change\nfrom exam dated ___ by report.\n\nIMPRESSION: No evidence of malignancy. BI-RADS 2 - benign findings.\n 19350368-RR-39 2131-12-30 09:06:00 INDICATION: Bilateral wrist pain, worse on the left.\n\nThree views of each wrist are obtained and interpreted without comparison. \nThere is no fracture or dislocation. Joint spaces are normal. Note is made\nof negative ulnar variance on the right. There are no radiopaque foreign\nbodies or soft tissue calcifications.\n 19350368-RR-40 2132-03-18 08:55:00 DIGITAL SCREENING MAMMOGRAM WITH ICAD\n\nINDICATION: Screening.\n\nRoutine and implant-displaced views were obtained.\n\nThere are scattered fibroglandular densities. There is a saline implant\nbehind the pectoralis in the right breast having much of the same appearance\nthat it did in mammography on ___. There are no suspicious masses or\ncalcifications. Post-reduction changes in the left breast are present.\n\nIMPRESSION:\n\nNo evidence of malignancy.\n\nBI-RADS 1 -- negative.\n 19350368-RR-41 2132-08-24 08:45:00 This is a transabdominal ___. A full timeout was performed. The patient had\nsigned an informed consent, and after sterile chloraprep of her abdomen, a\ntransabdominal ___ was performed. This was done under direct ultrasound\nguidance and clear visualization. The patient tolerated the procedure well,\nand post fetal heart rate was normal. The patient is O positive.\n\n 19350368-RR-42 2132-08-24 08:45:00 There is a single live intrauterine pregnancy with a crown-rump length of 54\nmm, which is measuring 12 weeks 1 day. The fetal heart rate was 155 beats per\nminute. There are normal, adnexa, uterus and no gross fetal abnormalities are\nnoted. The placenta is forming anteriorly.\n\n
Step 19
ehr ehr.think
response
Let me compile all the clinical information: Current admission (2133-02-28): - 46-year-old female admitted for vaginal delivery - DRG: Vaginal delivery without complicating diagnoses - Procedure ICD: 7359 - Other manually assisted delivery - Currently in Obstetrics postpartum unit - Low hemoglobin (10.3), low hematocrit (30.1%), microcytic indices (MCV 77, MCH 26.4) - iron deficiency anemia - Medications: Oxytocin (labor/postpartum), pain meds, sertraline, levothyroxine, trazodone, pantoprazole, ranitidine Medical history: - History of CVA/stroke (prior admission with DRG: CVA & precerebral occlusion with infarct) - On clopidogrel, aspirin, atorvastatin (from emar_detail showing past meds) - Hypothyroidism (on levothyroxine) - Depression (on sertraline) - Hyperlipidemia/high cholesterol (Total cholesterol 238, LDL 132-135) - GERD (on pantoprazole/ranitidine) - History of breast implant (right) and breast reduction (left) - Advanced maternal age (46 years old) - CVS performed at 12 weeks (prenatal genetic testing) in Aug 2132 The primary diagnosis for this admission would be: 1. Normal delivery/single liveborn (vaginal delivery) 2. Iron deficiency anemia / anemia complicating pregnancy 3. Hypothyroidism 4. Depression 5. History of CVA/stroke 6. Hyperlipidemia Now I need to find appropriate CCS diagnosis categories. Let me search for these in the diagnoses_ccs_candidates table.
Tool Response15 chars
Thinking Finish
Step 20
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword normal delivery
Tool Response94 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'normal delivery'.
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword vaginal delivery
Tool Response95 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'vaginal delivery'.
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword liveborn
Tool Response61 chars
icd_code icd_version candidate 76520 9 Liveborn
Step 21
ehr ehr.get_candidates_by_semantic_similarity
table_name diagnoses_ccs_candidates
query
[ "normal vaginal delivery", "iron deficiency anemia pregnancy", "hypothyroidism", "depression", "cerebrovascular disease stroke", "hyperlipidemia cholesterol", "advanced maternal age" ]
Tool Response3,104 chars
--- Semantic search results for 'normal vaginal delivery' --- Found 2 unique candidate names (threshold: 0.5, limit: 5) icd_code icd_version candidate semantic_similarity O3131X0 10 Other pregnancy and delivery including normal 0.872 66950 9 Forceps delivery 0.504 --- Semantic search results for 'iron deficiency anemia pregnancy' --- Found 4 unique candidate names (threshold: 0.5, limit: 5) icd_code icd_version candidate …
--- Semantic search results for 'normal vaginal delivery' ---
Found 2 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
O3131X0 10 Other pregnancy and delivery including normal 0.872
66950 9 Forceps delivery 0.504
--- Semantic search results for 'iron deficiency anemia pregnancy' ---
Found 4 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
O208 10 Hemorrhage during pregnancy; abruptio placenta; placenta previa 0.532
O26823 10 Other complications of pregnancy 0.532
64521 9 Prolonged pregnancy 0.529
P0509 10 Short gestation; low birth weight; and fetal growth retardation 0.523
--- Semantic search results for 'hypothyroidism' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
2452 9 Thyroid disorders 0.775
2598 9 Other endocrine disorders 0.681
E83118 10 Other nutritional; endocrine; and metabolic disorders 0.596
--- Semantic search results for 'depression' ---
Found 1 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
F3013 10 Mood disorders 0.647
--- Semantic search results for 'cerebrovascular disease stroke' ---
Found 5 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
G461 10 Other and ill-defined cerebrovascular disease 0.828
I63522 10 Acute cerebrovascular disease 0.828
I69091 10 Late effects of cerebrovascular disease 0.769
43310 9 Occlusion or stenosis of precerebral arteries 0.639
85313 9 Intracranial injury 0.621
--- Semantic search results for 'hyperlipidemia cholesterol' ---
Found 1 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
2722 9 Disorders of lipid metabolism 0.744
--- Semantic search results for 'advanced maternal age' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
64510 9 Prolonged pregnancy 0.614
O6022X1 10 Early or threatened labor 0.549
O3411 10 Other complications of pregnancy 0.508Step 22
ehr ehr.get_candidates_by_semantic_similarity
table_name diagnoses_ccs_candidates
query
[ "deficiency anemia", "GERD acid reflux", "other complications of pregnancy childbirth", "single liveborn", "outcome of delivery" ]
Tool Response2,682 chars
--- Semantic search results for 'deficiency anemia' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
D641 10 Deficiency and other anemia 0.912
M832 10 Nutritional deficiencies 0.699
2851 9 Acute posthemorrhagic anemia 0.541
--- Semantic search results for 'GERD acid reflux' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
B57…--- Semantic search results for 'deficiency anemia' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
D641 10 Deficiency and other anemia 0.912
M832 10 Nutritional deficiencies 0.699
2851 9 Acute posthemorrhagic anemia 0.541
--- Semantic search results for 'GERD acid reflux' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
B5731 10 Esophageal disorders 0.637
K3189 10 Other disorders of stomach and duodenum 0.636
R198 10 Other gastrointestinal disorders 0.524
--- Semantic search results for 'other complications of pregnancy childbirth' ---
Found 5 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
Z373 10 Other complications of pregnancy 0.945
O9A52 10 Other complications of birth; puerperium affecting management of mother 0.895
O480 10 Prolonged pregnancy 0.686
77013 9 Other perinatal conditions 0.636
O1404 10 Hypertension complicating pregnancy; childbirth and the puerperium 0.635
--- Semantic search results for 'single liveborn' ---
Found 1 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
V3101 9 Liveborn 0.638
--- Semantic search results for 'outcome of delivery' ---
Found 5 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
O30831 10 Other pregnancy and delivery including normal 0.760
66951 9 Forceps delivery 0.593
V351 9 Liveborn 0.559
65421 9 Previous C-section 0.549
66990 9 Other complications of birth; puerperium affecting management of mother 0.534 ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword anemia
Tool Response199 chars
icd_code icd_version candidate
2800 9 Deficiency and other anemia
28241 9 Sickle cell anemia
2851 9 Acute posthemorrhagic anemiaStep 23
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword pregnancy delivery
Tool Response97 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'pregnancy delivery'.
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword outcome of delivery
Tool Response98 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'outcome of delivery'.
Step 24
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword normal
Tool Response455 chars
icd_code icd_version candidate
64800 9 Diabetes or abnormal glucose tolerance complicating pregnancy; childbirth; or the puerperium
650 9 Other pregnancy and delivery including normal
65630 9 Fetal distress and abnormal forces of labor ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword delivery
Tool Response200 chars
icd_code icd_version candidate
650 9 Other pregnancy and delivery including normal
66950 9 Forceps deliveryStep 25
Assistant Message
Now let me search for more details about this patient's history to understand their stroke history better.
browser browser.search
query CCS diagnosis categories for vaginal delivery normal pregnancy
Tool Response2,747 chars
[0] CCS diagnosis categories for vaginal delivery normal pregnancy (web-search://ts=1776350031) **viewing lines [0 - 38] of 38** L0: L1: URL: web-search://ts=1776350031 L2: # Search Results L3: L4: * 【0†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 Other and L5: unspecified complications of birth; puerperium affecting management of mother. L6: 11.7. Normal pregnancy and/or delivery [196]. 11.7.1. Normal delivery. L7: * 【1†CCS Chapter 23 Flashcards - Quizlet†quizlet.com】 Final diagnoses: (1) L8: Normal spontaneous vaginal delivery, (2) repair of urethral and perineal L9: l…
[0] CCS diagnosis categories for vaginal delivery normal pregnancy (web-search://ts=1776350031) **viewing lines [0 - 38] of 38** L0: L1: URL: web-search://ts=1776350031 L2: # Search Results L3: L4: * 【0†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 Other and L5: unspecified complications of birth; puerperium affecting management of mother. L6: 11.7. Normal pregnancy and/or delivery [196]. 11.7.1. Normal delivery. L7: * 【1†CCS Chapter 23 Flashcards - Quizlet†quizlet.com】 Final diagnoses: (1) L8: Normal spontaneous vaginal delivery, (2) repair of urethral and perineal L9: lacerations. Assign the appropriate codes. O71.5, O70.0, Z37.0 ... L10: * 【2†[PDF] CCS Category Names (Full Labels) - New Health L11: Analytics†newhealthanalytics.com】 CATEGORIES SINGLE-LEVEL CCS DIAGNOSIS CATEGORY L12: LABELS. 1. Tuberculosis. 2 ... Normal pregnancy and/or delivery. 197. Skin and L13: subcutaneous tissue infections. L14: * 【3†[PDF] Clinical Classifications Software (CCS) Code List - IBIS-PH L15: -†ibis.utah.gov】 Other complications of birth. 195. Diagnostic ultrasound of L16: urinary tract. 196. Normal pregnancy and/or delivery. 196. Diagnostic ultrasound L17: of abdomen or ... L18: * 【4†Complicating Conditions of Vaginal Deliveries and Cesarean ... - L19: NCBI†www.ncbi.nlm.nih.gov】 Vaginal delivery stays · umbilical cord complications L20: (270 per 1,000 stays) · prolonged pregnancy (139 per 1,000 stays) · abnormality L21: in fetal heart rate or rhythm ... L22: * 【5†[PDF] icd-10 ccs category names (full labels)†hcup-us.ahrq.gov】 L23: CATEGORIES SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... L24: Normal pregnancy and/or delivery [196]. 12. Diseases of the skin and ... L25: * 【6†Pregnancy, Childbirth & the Puerperium - DRG Code Range L26: 768-833†www.aapc.com】 Pregnancy, Childbirth & the Puerperium. 768 · VAGINAL L27: DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C · 769 · POSTPARTUM L28: AND ... L29: * 【7†New DRG codes for C-sections and vaginal deliveries†www.mhswi.com】 L30: Recently, CMS announced changes to the Diagnosis Related Group (DRG) coding that L31: impacts billing for C-Sections and vaginal deliveries. L32: * 【8†[PDF] a provider's guide to diagnosis coding for L33: pregnancy†www.provider.wellpoint.com】 Conditions that affect the management of L34: pregnancy, childbirth, and the puerperium are classified in categories O00 L35: through O9A in chapter 15 of the ICD-10-CM. L36: * 【9†774 - ICD-10-CM/PCS MS-DRGv33 Definitions Manual†www.cms.gov】 O663, L37: Obstructed labor due to other abnormalities of fetus ; O6641, Failed attempted L38: vaginal birth after previous cesarean delivery ; O665, Attempted application ...
Step 26
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword Other pregnancy and delivery
Tool Response133 chars
icd_code icd_version candidate
650 9 Other pregnancy and delivery including normal ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword cerebrovascular
Tool Response267 chars
icd_code icd_version candidate
34660 9 Acute cerebrovascular disease
4370 9 Other and ill-defined cerebrovascular disease
4380 9 Late effects of cerebrovascular disease ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword thyroid
Tool Response116 chars
icd_code icd_version candidate
193 9 Cancer of thyroid
2400 9 Thyroid disorders ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword mood
Tool Response71 chars
icd_code icd_version candidate 29383 9 Mood disorders
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword lipid
Tool Response101 chars
icd_code icd_version candidate
2720 9 Disorders of lipid metabolismStep 27
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword esophag
Tool Response125 chars
icd_code icd_version candidate
1500 9 Cancer of esophagus
4561 9 Esophageal disorders ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword complications of pregnancy
Tool Response107 chars
icd_code icd_version candidate
630 9 Other complications of pregnancyStep 28
Assistant Message
Now let me search for information about what CCS diagnoses would be assigned for a vaginal delivery admission in a patient with this profile.
browser browser.search
query CCS single level diagnosis category 196 normal pregnancy delivery V27
Tool Response2,709 chars
[1] CCS single level diagnosis category 196 normal pregnancy delivery V27 (web-search://ts=1776350060) **viewing lines [0 - 38] of 38** L0: L1: URL: web-search://ts=1776350060 L2: # Search Results L3: L4: * 【0†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 CATEGORIES L5: SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... Normal L6: pregnancy and/or delivery [196]. 11.7.1. Normal delivery. 11.7.2. L7: * 【1†[PDF] CCS Category Names (Full Labels) - New Health L8: Analytics†newhealthanalytics.com】 CATEGORIES SINGLE-LEVEL CCS DIAGNOSIS CATEGORY L9: LABELS. 1. Tu…
[1] CCS single level diagnosis category 196 normal pregnancy delivery V27 (web-search://ts=1776350060) **viewing lines [0 - 38] of 38** L0: L1: URL: web-search://ts=1776350060 L2: # Search Results L3: L4: * 【0†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 CATEGORIES L5: SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... Normal L6: pregnancy and/or delivery [196]. 11.7.1. Normal delivery. 11.7.2. L7: * 【1†[PDF] CCS Category Names (Full Labels) - New Health L8: Analytics†newhealthanalytics.com】 CATEGORIES SINGLE-LEVEL CCS DIAGNOSIS CATEGORY L9: LABELS. 1. Tuberculosis. 2 ... Normal pregnancy and/or delivery. 197. Skin and L10: subcutaneous tissue infections. L11: * 【2†[PDF] icd-10 ccs category names (full labels)†hcup-us.ahrq.gov】 L12: CATEGORIES SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... L13: Normal pregnancy and/or delivery [196]. 12. Diseases of the skin and ... L14: * 【3†Table 3, Clinical codes used to identify delivery stays - NCBI - L15: NIH†www.ncbi.nlm.nih.gov】 Clinical codes used to identify delivery stays. L16: Abbreviations: CC, complications or comorbidities; D&C, dilation and curettage; L17: ICD-10-CM/PCS. L18: * 【4†CCS Category Names - HCUP - YUMPU†www.yumpu.com】 Single-Level L19: <strong>CCS</strong> and Multi-Level <strong>CCS ... 196 Normal pregnancy and/or L20: delivery<br />. 197 Skin and subcutaneous ... L21: * 【5†[PDF] Clinical Classifications Software (CCS) Code List - IBIS-PH L22: -†ibis.utah.gov】 Other complications of birth. 195. Diagnostic ultrasound of L23: urinary tract. 196. Normal pregnancy and/or delivery. 196. Diagnostic ultrasound L24: of abdomen or ... L25: * 【6†[PDF] AHRQ Clinical Classification System (CCS) - New Health L26: Analytics†newhealthanalytics.com】 single-level CCS diagnosis categories are L27: illustrated in Table 1. Table 1 ... 196 Normal pregnancy and/or delivery. 197 L28: Skin and subcutaneous tissue ... L29: * 【7†[PDF] clinical classifications software (ccs) 2015†hcup-us.ahrq.gov】 The L30: label for CCS diagnosis category 196 was changed as well. CCS consists of two L31: related classification systems. The first system, called the single-level CCS, L32: ... L33: * 【8†CCS for Diagnosis Codes - Healthy Data Science†healthydatascience.com】 L34: The Clinical Classification Software (CCS) for diagnosis codes is a software L35: tool developed as part of the Healthcare Cost and Utilization Project. L36: * 【9†Overview of CCS Medical Eligibility - DHCS†www.dhcs.ca.gov】 Neonates meet L37: eligibility criteria if they have a CCS eligible condition and need care in a L38: CCS-approved NICU due to that condition. Infants who ...
Step 29
ehr ehr.think
response
Let me now think about all the plausible diagnoses for this patient's current admission: Current admission context: - 46-year-old female admitted for vaginal delivery on 2133-02-28 - DRG: Vaginal delivery without complicating diagnoses - Procedure: Other manually assisted delivery - In postpartum obstetrics unit - Lab: Microcytic anemia (Hgb 10.3, Hct 30.1%, MCV 77, MCH 26.4) Medical history: - History of stroke/CVA (prior admission) - Hypothyroidism (on levothyroxine) - Depression (on sertraline, trazodone) - Hyperlipidemia (on atorvastatin in past, elevated cholesterol) - GERD (on pantoprazole, ranitidine) - Advanced maternal age (46 years old) - History of breast implant and reduction The primary diagnosis codes for this admission would be: 1. "Other pregnancy and delivery including normal" - This is the main delivery diagnosis. The DRG says vaginal delivery without complicating diagnoses. 2. "Liveborn" - Outcome of delivery, single liveborn infant. Though this is typically assigned to the baby's record, it could appear as V code on the mother's record. 3. "Deficiency and other anemia" - Microcytic anemia with low Hgb, Hct, MCV, MCH. Likely iron deficiency anemia in pregnancy. 4. "Thyroid disorders" - Hypothyroidism, on levothyroxine 5. "Late effects of cerebrovascular disease" - History of stroke, now in the late effects period 6. "Disorders of lipid metabolism" - Hyperlipidemia 7. "Mood disorders" - Depression, on sertraline 8. "Esophageal disorders" - GERD, on pantoprazole/ranitidine 9. "Other complications of pregnancy" - Advanced maternal age, history of stroke could be a complicating factor Let me also consider the OB-specific CCS codes. The patient had an assisted delivery. Let me check if there's a specific CCS for that.
Tool Response15 chars
Thinking Finish
Step 30
ehr ehr.get_candidates_by_semantic_similarity
table_name diagnoses_ccs_candidates
query
[ "other specified conditions and aftercare", "outcome of delivery liveborn single", "screening examination" ]
Tool Response1,416 chars
--- Semantic search results for 'other specified conditions and aftercare' --- Found 3 unique candidate names (threshold: 0.5, limit: 5) icd_code icd_version candidate semantic_similarity Z4582 10 Other aftercare 0.895 99977 9 Complications of surgical procedures or medical care 0.543 E8762 9 E Codes: Adverse effects of medical care 0.507 --- Semantic search results for 'outcome of delivery liveborn single' --- Found 2 …
--- Semantic search results for 'other specified conditions and aftercare' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
Z4582 10 Other aftercare 0.895
99977 9 Complications of surgical procedures or medical care 0.543
E8762 9 E Codes: Adverse effects of medical care 0.507
--- Semantic search results for 'outcome of delivery liveborn single' ---
Found 2 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
Z3864 10 Liveborn 0.732
O30801 10 Other pregnancy and delivery including normal 0.630
--- Semantic search results for 'screening examination' ---
Found 2 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
R928 10 Other screening for suspected conditions (not mental disorders or infectious disease) 0.663
V7285 9 Medical examination/evaluation 0.644 ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword previous cesarean
Tool Response96 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'previous cesarean'.
Step 31
ehr ehr.get_candidates_by_semantic_similarity
table_name diagnoses_ccs_candidates
query
[ "postpartum hemorrhage blood loss delivery", "perineal laceration delivery" ]
Tool Response1,161 chars
--- Semantic search results for 'postpartum hemorrhage blood loss delivery' ---
Found 4 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
65140 9 Other complications of birth; puerperium affecting management of mother 0.593
O4453 10 Hemorrhage during pregnancy; abruptio placenta; placenta previa 0.565
2851 9 Acute posthemorrhagic anemia 0.553
O3689…--- Semantic search results for 'postpartum hemorrhage blood loss delivery' ---
Found 4 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
65140 9 Other complications of birth; puerperium affecting management of mother 0.593
O4453 10 Hemorrhage during pregnancy; abruptio placenta; placenta previa 0.565
2851 9 Acute posthemorrhagic anemia 0.553
O368912 10 Other complications of pregnancy 0.543
--- Semantic search results for 'perineal laceration delivery' ---
Found 3 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
66454 9 OB-related trauma to perineum and vulva 0.641
66951 9 Forceps delivery 0.572
P143 10 Birth trauma 0.554 ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword complication birth puerperium
Tool Response108 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'complication birth puerperium'.
Step 32
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword OB-related trauma
Tool Response121 chars
icd_code icd_version candidate 66400 9 OB-related trauma to perineum and vulva
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword complications of birth
Tool Response185 chars
icd_code icd_version candidate 64970 9 Other complications of birth; puerperium affecting management of mother
Step 33
Assistant Message
Now let me search for more context on whether advanced maternal age would be coded under "Other complications of pregnancy":
browser browser.search
query ICD-9 659.6 elderly multigravida CCS classification category
Tool Response2,696 chars
[2] ICD-9 659.6 elderly multigravida CCS classification category (web-search://ts=1776350106) **viewing lines [0 - 36] of 36** L0: L1: URL: web-search://ts=1776350106 L2: # Search Results L3: L4: * 【0†ICD-9 Code 659.6 -Elderly mutigravida- Codify by AAPC†www.aapc.com】 ICD-9 L5: code 659.6 for Elderly mutigravida is a medical classification as listed by WHO L6: under the range - NORMAL DELIVERY, AND OTHER INDICATIONS FOR CAR. L7: * 【1†ICD-9-CM Diagnosis Code 659.6 : Elderly multigravida†www.icd9data.com】 L8: There are 3 ICD-9-CM codes below 659.6 that define this diagnosis in greater …
[2] ICD-9 659.6 elderly multigravida CCS classification category (web-search://ts=1776350106) **viewing lines [0 - 36] of 36** L0: L1: URL: web-search://ts=1776350106 L2: # Search Results L3: L4: * 【0†ICD-9 Code 659.6 -Elderly mutigravida- Codify by AAPC†www.aapc.com】 ICD-9 L5: code 659.6 for Elderly mutigravida is a medical classification as listed by WHO L6: under the range - NORMAL DELIVERY, AND OTHER INDICATIONS FOR CAR. L7: * 【1†ICD-9-CM Diagnosis Code 659.6 : Elderly multigravida†www.icd9data.com】 L8: There are 3 ICD-9-CM codes below 659.6 that define this diagnosis in greater L9: detail. Do not use this code on a reimbursement claim. L10: * 【2†ICD-9 Code 659.60 -Elderly multigravida, unspecified as to episode L11: ...†www.aapc.com】 ICD-9 code 659.60 for Elderly multigravida, unspecified as to L12: episode of care or not applicable is a medical classification as listed by WHO. L13: * 【3†659.60 Elderly multigravida-uns - ICD-9-CM Vol. 1 Diagnostic L14: Codes†www.findacode.com】 659.6 Elderly multigravida. 659.60 Elderly L15: multigravida, unspecified as to ... CCS Clinical Classification; Co-Surgeons L16: (62); Diagnostic Imaging Family ... L17: * 【4†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 CCS. DIAGNOSIS. L18: CATEGORIES. MULTI-LEVEL CCS DIAGNOSIS CATEGORY LABELS. [Single-Level CCS L19: Diagnosis Category]. 1. Infectious and parasitic diseases. 1.1. L20: * 【5†ICD-9-CM Diagnosis Code 659.61 : Elderly multigravida, delivered L21: ...†www.icd9data.com】 659.61 is only applicable to maternity patients aged 12 - L22: 55 years inclusive. · 659.61 is only applicable to female patients. L23: * 【6†Convert ICD-9-CM Diagnosis 659.60 to ICD-10-CM†www.icd10data.com】 L24: ICD-9-CM 659.60 converts approximately to: 2026 ICD-10-CM O09.529 Supervision of L25: elderly multigravida, unspecified trimester. Note: approximate conversions ... L26: * 【7†Table 9, ICD-9-CM diagnosis and CCS codes defining coexisting L27: ...†www.ncbi.nlm.nih.gov】 ICD-9-CM diagnosis code or CCS category, Description, L28: Condition. 648.2, Anemia, Anemia. 280, Iron deficiency anemias. 281, Other L29: deficiency anemias. L30: * 【8†Elderly Multigravida - Advanced Women's Care†advancedwomens.care】 Elderly L31: multigravida refers to a woman aged 35 or older who has been pregnant more than L32: once. While “elderly” may sound outdated, it's a medical term ... L33: * 【9†[PDF] Table e-1. ICD-9-CM diagnosis codes for pregnancy and delivery†cdn- L34: links.lww.com】 Supervision of high-risk pregnancy with elderly primigravida. L35: V23.82. Supervision of high-risk pregnancy with elderly multigravida. V23.83. L36: Supervision of high ...
Step 34
browser browser.open
id 3
Tool Response1,254 chars
[3] 659.60 Elderly multigravida-uns - ICD-9-CM Vol. 1 Diagnostic Codes (https://www.findacode.com/icd-9/659-60-elderly-multigravida-unspecified-episode-care-icd-9-code.html) **viewing lines [0 - 14] of 14** L0: L1: URL: https://www.findacode.com/icd-9/659-60-elderly-multigravida-unspecified- L2: episode-care-icd-9-code.html L3: 659.60 Elderly multigravida-uns 659.60 Elderly multigravida, unspecified as to L4: episode of care or not applicable... 659.60 - Elderly multigravida, unspecified L5: as to episode of care or not applicable auto-open Additional Code Information L6: auto-open ICD-9 …
[3] 659.60 Elderly multigravida-uns - ICD-9-CM Vol. 1 Diagnostic Codes (https://www.findacode.com/icd-9/659-60-elderly-multigravida-unspecified-episode-care-icd-9-code.html) **viewing lines [0 - 14] of 14** L0: L1: URL: https://www.findacode.com/icd-9/659-60-elderly-multigravida-unspecified- L2: episode-care-icd-9-code.html L3: 659.60 Elderly multigravida-uns 659.60 Elderly multigravida, unspecified as to L4: episode of care or not applicable... 659.60 - Elderly multigravida, unspecified L5: as to episode of care or not applicable auto-open Additional Code Information L6: auto-open ICD-9 v1 Index Entries (Reverse Index Lookup) auto-open Code History L7: auto-open Dictionary Definitions auto-open My Notes auto-open Alerts (1 alert) L8: auto-open Articles & Newsletters auto-open Coding Tips auto-open Web-A-Code - L9: Useful Web Links auto-open Medical Laboratory Tests auto-open ICD-9 MS-DRG L10: Grouper Logic auto-open ICD-10 Cross-A-Code™ (GEMs & RMs) auto-open Cross-A- L11: Code™ (ICD-9/10, CPT, Modifiers, NCCI, NDC, ASA CROSSWALK®) auto-open Medicare L12: Policies & Guidelines (Articles, LCDs, NCDs) auto-open QPP (Quality Payment L13: Program) Measures Thank you for choosing Find-A-Code, please Sign In to remove L14: ads.
Step 35
browser browser.search
query ICD-9 659.6 CCS single level category number other complications pregnancy
Tool Response2,838 chars
[4] ICD-9 659.6 CCS single level category number other complications pregnancy (web-search://ts=1776350118) **viewing lines [0 - 40] of 40** L0: L1: URL: web-search://ts=1776350118 L2: # Search Results L3: L4: * 【0†List of ICD-9 codes 630–679: complications of pregnancy, childbirth L5: ...†en.wikipedia.org】 This is a shortened version of the eleventh chapter of the L6: ICD-9: Complications of Pregnancy, Childbirth, and the Puerperium. It covers L7: ICD codes 630 to 679. L8: * 【1†ICD-9 Code COMPLICATIONS OF PREGNANCY, CHILDBIRTH ...†www.aapc.com】 ICD-9 L9: Code range (630-679), COMPL…
[4] ICD-9 659.6 CCS single level category number other complications pregnancy (web-search://ts=1776350118) **viewing lines [0 - 40] of 40** L0: L1: URL: web-search://ts=1776350118 L2: # Search Results L3: L4: * 【0†List of ICD-9 codes 630–679: complications of pregnancy, childbirth L5: ...†en.wikipedia.org】 This is a shortened version of the eleventh chapter of the L6: ICD-9: Complications of Pregnancy, Childbirth, and the Puerperium. It covers L7: ICD codes 630 to 679. L8: * 【1†ICD-9 Code COMPLICATIONS OF PREGNANCY, CHILDBIRTH ...†www.aapc.com】 ICD-9 L9: Code range (630-679), COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND THE L10: PUERPERIUM, contains ICD-9 codes for ECTOPIC AND MOLAR PREGNANCY, PREGNANC. L11: * 【2†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 CATEGORIES L12: SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... Other L13: complications of pregnancy [181]. 11.3.7.1. Infections of genitourinary ... L14: * 【3†Table 4, ICD-9-CM codes used to define complicating L15: conditions†www.ncbi.nlm.nih.gov】 Normal delivery and other indications for care L16: in pregnancy, labor, and delivery (650–659), Other Indications for Care or L17: Intervention Related to Labor and ... L18: * 【4†[PDF] Diagnostic Codes (ICD9) Pregnancy Childbirth L19: Puerperium†www2.gov.bc.ca】 LIVER DISORDERS IN PREGNANCY. 646.8. OTHER SPECIFIED L20: COMPLICATIONS OF PREGNANCY. 646.9. UNSPECIFIED COMPLICATION OF PREGNANCY. 647. L21: INFECTIVE AND PARASITIC ... L22: * 【5†[PDF] CCS Category Names (Full Labels) - New Health L23: Analytics†newhealthanalytics.com】 CATEGORIES SINGLE-LEVEL CCS DIAGNOSIS CATEGORY L24: LABELS. 1. Tuberculosis. 2 ... Other complications of pregnancy. 182. L25: Hemorrhage during pregnancy; abruptio ... L26: * 【6†Medical Codes - ICD-9-CM - Find-A-Code†www.findacode.com】 NORMAL L27: DELIVERY, AND OTHER INDICATIONS FOR CARE IN PREGNANCY, LABOR, AND DELIVERY L28: (650-659) →. section notes. This section may also have Includes, Excludes, ... L29: * 【7†[PDF] Table e-1. ICD-9-CM diagnosis codes for pregnancy and delivery†cdn- L30: links.lww.com】 Table e-1. ICD-9-CM diagnosis codes for pregnancy and delivery. L31: Code. Diagnosis. Ectopic and molar pregnancy (630-633.91). 630. Hydatidiform L32: mole. L33: * 【8†[PDF] Supplementary Appendix 1: Crosswalk of ICD-9-CM codes to CCS L34: ...†ijpds.org】 Supplementary Appendix 1: Crosswalk of ICD-9-CM codes to CCS L35: categories. CCS. CCS category. ICD-9- category # description. CM code. ICD-9-CM L36: code label. 11. L37: * 【9†Table 3, ICD-9-CM and CCS diagnosis codes for defining ... - L38: NCBI†www.ncbi.nlm.nih.gov】 181: Other complications of pregnancy. 182: L39: Hemorrhage during pregnancy ... All other diagnoses including but not limited to L40: cancer of breast (CCS category ...
Step 36
browser browser.open
id 2
loc 0
Tool Response4,188 chars
[5] hcup-us.ahrq.gov (https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf) **viewing lines [0 - 49] of 866** L0: L1: URL: https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf L2: CCS CATEGORY NAMES (FULL LABELS) Single-Level CCS and Multi-Level CCS Single- L3: Level CCS - Diagnoses SINGLE-LEVEL CCS DIAGNOSIS CATEGORIES SINGLE-LEVEL CCS L4: DIAGNOSIS CATEGORY LABELS 1 Tuberculosis 2 Septicemia (except in labor) 3 L5: Bacterial infection; unspecified site 4 Mycoses 5 HIV infection 6 Hepatitis 7 L6: Viral infection 8 Other infections; including pa…
[5] hcup-us.ahrq.gov (https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf) **viewing lines [0 - 49] of 866** L0: L1: URL: https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf L2: CCS CATEGORY NAMES (FULL LABELS) Single-Level CCS and Multi-Level CCS Single- L3: Level CCS - Diagnoses SINGLE-LEVEL CCS DIAGNOSIS CATEGORIES SINGLE-LEVEL CCS L4: DIAGNOSIS CATEGORY LABELS 1 Tuberculosis 2 Septicemia (except in labor) 3 L5: Bacterial infection; unspecified site 4 Mycoses 5 HIV infection 6 Hepatitis 7 L6: Viral infection 8 Other infections; including parasitic 9 Sexually transmitted L7: infections (not HIV or hepatitis) 10 Immunizations and screening for infectious L8: disease 11 Cancer of head and neck 12 Cancer of esophagus 13 Cancer of stomach L9: 14 Cancer of colon 15 Cancer of rectum and anus 16 Cancer of liver and L10: intrahepatic bile duct 17 Cancer of pancreas 18 Cancer of other GI organs; L11: peritoneum 19 Cancer of bronchus; lung 20 Cancer; other respiratory and L12: intrathoracic 21 Cancer of bone and connective tissue 22 Melanomas of skin 23 L13: Other non-epithelial cancer of skin 24 Cancer of breast 25 Cancer of uterus 26 L14: Cancer of cervix 27 Cancer of ovary 28 Cancer of other female genital organs 29 L15: Cancer of prostate 30 Cancer of testis 31 Cancer of other male genital organs 32 L16: Cancer of bladder 33 Cancer of kidney and renal pelvis 34 Cancer of other L17: urinary organs 35 Cancer of brain and nervous system 36 Cancer of thyroid 37 L18: Hodgkins disease 38 Non-Hodgkins lymphoma 39 Leukemias 40 Multiple myeloma 41 L19: Cancer; other and unspecified primary 42 Secondary malignancies 43 Malignant L20: neoplasm without specification of site 44 Neoplasms of unspecified nature or L21: uncertain behavior 45 Maintenance chemotherapy; radiotherapy 46 Benign neoplasm L22: of uterus 47 Other and unspecified benign neoplasm 48 Thyroid disorders �49 L23: Diabetes mellitus without complication 50 Diabetes mellitus with complications L24: 51 Other endocrine disorders 52 Nutritional deficiencies 53 Disorders of lipid L25: metabolism 54 Gout and other crystal arthropathies 55 Fluid and electrolyte L26: disorders 56 Cystic fibrosis 57 Immunity disorders 58 Other nutritional; L27: endocrine; and metabolic disorders 59 Deficiency and other anemia 60 Acute L28: posthemorrhagic anemia 61 Sickle cell anemia 62 Coagulation and hemorrhagic L29: disorders 63 Diseases of white blood cells 64 Other hematologic conditions 650 L30: Adjustment disorders 651 Anxiety disorders 652 Attention-deficit, conduct, and L31: disruptive behavior disorders 653 Delirium, dementia, and amnestic and other L32: cognitive disorders 654 Developmental disorders 655 Disorders usually diagnosed L33: in infancy, childhood, or adolescence 656 Impulse control disorders, NEC 657 L34: Mood disorders 658 Personality disorders 659 Schizophrenia and other psychotic L35: disorders 660 Alcohol-related disorders 661 Substance-related disorders 662 L36: Suicide and intentional self-inflicted injury 663 Screening and history of L37: mental health and substance abuse codes 670 Miscellaneous mental health L38: disorders 76 Meningitis (except that caused by tuberculosis or sexually L39: transmitted disease) 77 Encephalitis (except that caused by tuberculosis or L40: sexually transmitted disease) 78 Other CNS infection and poliomyelitis 79 L41: Parkinsons disease 80 Multiple sclerosis 81 Other hereditary and degenerative L42: nervous system conditions 82 Paralysis 83 Epilepsy; convulsions 84 Headache; L43: including migraine 85 Coma; stupor; and brain damage 86 Cataract 87 Retinal L44: detachments; defects; vascular occlusion; and retinopathy 88 Glaucoma 89 L45: Blindness and vision defects 90 Inflammation; infection of eye (except that L46: caused by tuberculosis or sexually transmitteddisease) 91 Other eye disorders 92 L47: Otitis media and related conditions 93 Conditions associated with dizziness or L48: vertigo 94 Other ear and sense organ disorders 95 Other nervous system disorders L49: 96 Heart valve disorders 97 Peri-; endo-; and myocarditis; cardiomyopathy
Step 37
browser browser.find
pattern pregnancy
cursor 5
Tool Response3,486 chars
[6] Find results for text: `pregnancy` in `hcup-us.ahrq.gov` (https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf/find?pattern=pregnancy) **viewing lines [0 - 54] of 70** L0: # 【0†match at L90】 L1: Postabortion complications 180 Ectopic pregnancy 181 Other complications of L2: pregnancy 182 Hemorrhage during pregnancy; abruptio placenta; placenta previa L3: 183 Hypertension complicating pregnancy; childbirth and the puerperium 184 Early L4: or threatened labor 185 Prolonged pregnancy 186 Diabetes or abnormal glucose L5: L6: # 【1†match at L94】 L7: tolerance complica…
[6] Find results for text: `pregnancy` in `hcup-us.ahrq.gov` (https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf/find?pattern=pregnancy) **viewing lines [0 - 54] of 70** L0: # 【0†match at L90】 L1: Postabortion complications 180 Ectopic pregnancy 181 Other complications of L2: pregnancy 182 Hemorrhage during pregnancy; abruptio placenta; placenta previa L3: 183 Hypertension complicating pregnancy; childbirth and the puerperium 184 Early L4: or threatened labor 185 Prolonged pregnancy 186 Diabetes or abnormal glucose L5: L6: # 【1†match at L94】 L7: tolerance complicating pregnancy; childbirth; or the puerperium 187 Malposition; L8: malpresentation 188 Fetopelvic disproportion; obstruction 189 Previous L9: C-section 190 Fetal distress and abnormal forces of labor 191 Polyhydramnios and L10: other problems of amniotic cavity 192 Umbilical cord complication 193 OB- L11: L12: # 【2†match at L100】 L13: pregnancy and delivery including normal 197 Skin and subcutaneous tissue L14: infections 198 Other inflammatory condition of skin 199 Chronic ulcer of skin L15: 200 Other skin disorders 201 Infective arthritis and osteomyelitis (except that L16: caused by tuberculosis or sexually transmitted disease) 202 Rheumatoid arthritis L17: L18: # 【3†match at L207】 L19: 121 Ligation or occlusion of fallopian tubes 122 Removal of ectopic pregnancy L20: 123 Other operations on fallopian tubes 124 Hysterectomy; abdominal and vaginal L21: 125 Other excision of cervix and uterus 126 Abortion (termination of pregnancy) L22: 127 Dilatation and curettage (D&C); aspiration after delivery or abortion 128 L23: L24: # 【4†match at L506】 L25: unspecified female genital disorders 11 Complications of pregnancy; childbirth; L26: and the puerperium 11.1 Contraceptive and procreative management [176] 11.1.1 L27: Sterilization 11.1.2 Other contraceptive and procreation management 11.2 L28: Abortion-related disorders 11.2.1 Spontaneous abortion [177] 11.2.2 Induced L29: L30: # 【5†match at L511】 L31: related to pregnancy 11.3.1 Ectopic pregnancy [180] 11.3.2 Hemorrhage during L32: pregnancy; abruptio placenta; placenta previa [182] 11.3.2.1 Placenta previa L33: 11.3.2.2 Abruptio placenta 11.3.2.3 Other hemorrhage during pregnancy; L34: childbirth and the puerperium 11.3.3 Hypertension complicating pregnancy; L35: L36: # 【6†match at L516】 L37: Other hypertension in pregnancy 11.3.4 Early or threatened labor [184] 11.3.4.1 L38: Threatened premature labor 11.3.4.2 Early onset of delivery 11.3.4.3 Other L39: early or threatened labor 11.3.5 Prolonged pregnancy [185] 11.3.6 Diabetes or L40: abnormal glucose tolerance complicating pregnancy; childbirth; or the puerperium L41: L42: # 【7†match at L520】 L43: [186] 11.3.7 Other complications of pregnancy [181] 11.3.7.1 Infections of L44: genitourinary tract during pregnancy 11.3.7.2 Anemia during pregnancy 11.3.7.3 L45: Mental disorders during pregnancy 11.3.7.4 Missed abortion 11.3.7.5 Hyperemesis L46: gravidarum 11.3.7.6 Infectious and parasitic complications in mother affecting L47: L48: # 【8†match at L524】 L49: pregnancy 11.3.7.7 Other and unspecified complications of pregnancy 11.4 L50: Indications for care in pregnancy; labor; and delivery 11.4.1 Malposition; L51: malpresentation [187] 11.4.1.1 Breech presentation 11.4.1.2 Other malposition; L52: malpresentation 11.4.2 Fetopelvic disproportion; obstruction [188] 11.4.2.1 L53: L54: # 【9†match at L546】
Step 38
browser browser.open
id 5
loc 86
num_lines 30
Tool Response2,636 chars
[7] hcup-us.ahrq.gov (https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf) **viewing lines [86 - 115] of 866** L86: diseases of female pelvic organs 169 Endometriosis 170 Prolapse of female L87: genital organs 171 Menstrual disorders 172 Ovarian cyst 173 Menopausal disorders L88: 174 Female infertility 175 Other female genital disorders 176 Contraceptive and L89: procreative management 177 Spontaneous abortion 178 Induced abortion 179 L90: Postabortion complications 180 Ectopic pregnancy 181 Other complications of L91: pregnancy 182 Hemorrhage during pregnancy; ab…
[7] hcup-us.ahrq.gov (https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf) **viewing lines [86 - 115] of 866** L86: diseases of female pelvic organs 169 Endometriosis 170 Prolapse of female L87: genital organs 171 Menstrual disorders 172 Ovarian cyst 173 Menopausal disorders L88: 174 Female infertility 175 Other female genital disorders 176 Contraceptive and L89: procreative management 177 Spontaneous abortion 178 Induced abortion 179 L90: Postabortion complications 180 Ectopic pregnancy 181 Other complications of L91: pregnancy 182 Hemorrhage during pregnancy; abruptio placenta; placenta previa L92: 183 Hypertension complicating pregnancy; childbirth and the puerperium 184 Early L93: or threatened labor 185 Prolonged pregnancy 186 Diabetes or abnormal glucose L94: tolerance complicating pregnancy; childbirth; or the puerperium 187 Malposition; L95: malpresentation 188 Fetopelvic disproportion; obstruction 189 Previous L96: C-section 190 Fetal distress and abnormal forces of labor 191 Polyhydramnios and L97: other problems of amniotic cavity 192 Umbilical cord complication 193 OB- L98: related trauma to perineum and vulva 194 Forceps delivery 195 Other L99: complications of birth; puerperium affecting management of mother 196 Other L100: pregnancy and delivery including normal 197 Skin and subcutaneous tissue L101: infections 198 Other inflammatory condition of skin 199 Chronic ulcer of skin L102: 200 Other skin disorders 201 Infective arthritis and osteomyelitis (except that L103: caused by tuberculosis or sexually transmitted disease) 202 Rheumatoid arthritis L104: and related disease 203 Osteoarthritis 204 Other non-traumatic joint disorders L105: 205 Spondylosis; intervertebral disc disorders; other back problems 206 L106: Osteoporosis 207 Pathological fracture 208 Acquired foot deformities 209 Other L107: acquired deformities 210 Systemic lupus erythematosus and connective tissue L108: disorders 211 Other connective tissue disease 212 Other bone disease and L109: musculoskeletal deformities 213 Cardiac and circulatory congenital anomalies 214 L110: Digestive congenital anomalies 215 Genitourinary congenital anomalies 216 L111: Nervous system congenital anomalies 217 Other congenital anomalies 218 Liveborn L112: �219 Short gestation; low birth weight; and fetal growth retardation 220 L113: Intrauterine hypoxia and birth asphyxia 221 Respiratory distress syndrome 222 L114: Hemolytic jaundice and perinatal jaundice 223 Birth trauma 224 Other perinatal L115: conditions 225 Joint disorders and dislocations; trauma-related 226 Fracture of
Step 39
ehr ehr.think
response
Now I have a good understanding of the CCS categories. Let me compile the plausible diagnoses for this current admission: From the CCS full labels (AHRQ), the relevant categories are: 1. **196: Other pregnancy and delivery including normal** - This is the primary diagnosis for the vaginal delivery admission. The DRG code confirms "vaginal delivery without complicating diagnoses." 2. **218: Liveborn** - Outcome of delivery. V27 codes (outcome of delivery) map to CCS 218. Although this is typically on the newborn's record, the mother may also get this as an outcome code. 3. **59: Deficiency and other anemia** - The patient has microcytic anemia (Hgb 10.3, MCV 77). This is iron deficiency anemia, likely related to pregnancy. 4. **48: Thyroid disorders** - Hypothyroidism, confirmed by levothyroxine use. 5. **657: Mood disorders** - Depression, confirmed by sertraline use. 6. **53: Disorders of lipid metabolism** - Elevated cholesterol (Total 238, LDL 132-135). 7. **109: Late effects of cerebrovascular disease** - History of CVA/stroke from prior admission, now on anti-platelet therapy. 8. **181: Other complications of pregnancy** - Advanced maternal age (46) is coded under "elderly multigravida" which maps to CCS 181. Also, anemia during pregnancy is a subcategory under 181. 9. **140: Esophageal disorders** - GERD, confirmed by pantoprazole/ranitidine use. Actually, let me reconsider which ones are most plausible for the current admission. The DRG is "vaginal delivery without complicating diagnoses" which suggests the primary focus is the delivery. The secondary diagnoses would include her chronic conditions. Let me finalize the list. I should focus on what would be coded as diagnoses on this hospital stay.
Tool Response15 chars
Thinking Finish
Step 40
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword late effects cerebrovascular
Tool Response107 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'late effects cerebrovascular'.
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword Deficiency and other anemia
Tool Response97 chars
icd_code icd_version candidate
2800 9 Deficiency and other anemiaStep 41
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword Late effects of cerebrovascular
Tool Response121 chars
icd_code icd_version candidate
4380 9 Late effects of cerebrovascular diseaseStep 42
Assistant Message
Now let me verify that all the exact CCS names I plan to use are valid:
ehr ehr.get_candidates_by_fuzzy_matching
table_name diagnoses_ccs_candidates
keywords
[ "Other pregnancy and delivery including normal", "Liveborn", "Deficiency and other anemia", "Thyroid disorders", "Mood disorders", "Disorders of lipid metabolism", "Late effects of cerebrovascular disease", "Other complications of pregnancy", "Esophageal disorders" ]
Tool Response4,930 chars
--- Results for keyword 'Other pregnancy and delivery including normal' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
O30109 10 Other pregnancy and delivery including normal 100
B658 10 Other infections; including parasitic 54
H61019 10 Other ear and sense organ disorders 52
33523 9 Other hereditary and degenerative nervous system conditions 52
Z8…--- Results for keyword 'Other pregnancy and delivery including normal' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
O30109 10 Other pregnancy and delivery including normal 100
B658 10 Other infections; including parasitic 54
H61019 10 Other ear and sense organ disorders 52
33523 9 Other hereditary and degenerative nervous system conditions 52
Z86010 10 Other and unspecified benign neoplasm 51
--- Results for keyword 'Liveborn' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
V362 9 Liveborn 100
63571 9 Induced abortion 50
R75 10 HIV infection 48
T2230XS 10 Burns 46
05411 9 Viral infection 43
--- Results for keyword 'Deficiency and other anemia' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
D513 10 Deficiency and other anemia 100
D62 10 Acute posthemorrhagic anemia 55
D57812 10 Sickle cell anemia 53
5400 9 Appendicitis and other appendiceal conditions 53
K436 10 Abdominal hernia 51
--- Results for keyword 'Thyroid disorders' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
2410 9 Thyroid disorders 100
29600 9 Mood disorders 77
R2240 10 Other skin disorders 76
H442D1 10 Other eye disorders 72
R456 10 Anxiety disorders 71
--- Results for keyword 'Mood disorders' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
29646 9 Mood disorders 100
E041 10 Thyroid disorders 77
N924 10 Menopausal disorders 71
I459 10 Conduction disorders 71
D8189 10 Immunity disorders 69
--- Results for keyword 'Disorders of lipid metabolism' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
E781 10 Disorders of lipid metabolism 100
K004 10 Disorders of teeth and jaw 58
D72810 10 Diseases of white blood cells 52
K135 10 Diseases of mouth; excluding dental 50
K3184 10 Other disorders of stomach and duodenum 50
--- Results for keyword 'Late effects of cerebrovascular disease' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
I69049 10 Late effects of cerebrovascular disease 100
I63313 10 Acute cerebrovascular disease 79
G461 10 Other and ill-defined cerebrovascular disease 71
44629 9 Other circulatory disease 56
4358 9 Transient cerebral ischemia 52
--- Results for keyword 'Other complications of pregnancy' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
O9A219 10 Other complications of pregnancy 100
63390 9 Ectopic pregnancy 65
O0881 10 Postabortion complications 59
64523 9 Prolonged pregnancy 59
66912 9 Other complications of birth; puerperium affecting management of mother 58
--- Results for keyword 'Esophageal disorders' (threshold: 0, limit: 5) ---
icd_code icd_version candidate similarity_score
K223 10 Esophageal disorders 100
6273 9 Menopausal disorders 80
317 9 Developmental disorders 74
30189 9 Personality disorders 73
N913 10 Menstrual disorders 72Step 43
Assistant Message
All the CCS names I want to use are valid. Now let me review one more time to make sure my diagnosis list is comprehensive and accurate.
browser browser.search
query ICD-9 V27.0 outcome delivery single liveborn CCS category classification
Tool Response2,526 chars
[8] ICD-9 V27.0 outcome delivery single liveborn CCS category classification (web-search://ts=1776350171) **viewing lines [0 - 36] of 36** L0: L1: URL: web-search://ts=1776350171 L2: # Search Results L3: L4: * 【0†ICD-9-CM Diagnosis Code V27.0 : Outcome of delivery, single L5: ...†www.icd9data.com】 V27.0 is only applicable to maternity patients aged 12 - L6: 55 years inclusive. V27.0 is only applicable to female patients. L7: * 【1†V27.0 Deliver-single liveborn - ICD-9-CM Vol. 1 Diagnostic L8: Codes†www.findacode.com】 V27 Outcome of delivery. V27.0 Outcome of delivery, L9: single live…
[8] ICD-9 V27.0 outcome delivery single liveborn CCS category classification (web-search://ts=1776350171) **viewing lines [0 - 36] of 36** L0: L1: URL: web-search://ts=1776350171 L2: # Search Results L3: L4: * 【0†ICD-9-CM Diagnosis Code V27.0 : Outcome of delivery, single L5: ...†www.icd9data.com】 V27.0 is only applicable to maternity patients aged 12 - L6: 55 years inclusive. V27.0 is only applicable to female patients. L7: * 【1†V27.0 Deliver-single liveborn - ICD-9-CM Vol. 1 Diagnostic L8: Codes†www.findacode.com】 V27 Outcome of delivery. V27.0 Outcome of delivery, L9: single liveborn... Goto ... CCS Clinical Classification; Co-Surgeons (62); L10: Diagnostic Imaging Family ... L11: * 【2†Outcome of delivery ( V27 ) - ICD-9 Codes - AAPC†www.aapc.com】 ICD-9 code L12: V27 for Outcome of delivery is a medical classification as listed by WHO under L13: the range - PERSONS ENCOUNTERING HEALTH SERVICES IN CIRCUMST. L14: * 【3†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 CATEGORIES L15: SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... Outcome of L16: delivery (V codes). 12. Diseases of the skin and subcutaneous ... L17: * 【4†Table 9, ICD-9-CM diagnosis and CCS codes defining coexisting L18: ...†www.ncbi.nlm.nih.gov】 V27.3, Twins, one liveborn and one stillborn. V27.4, L19: Twins, both stillborn. V27.5, Other multiple birth, all liveborn. V27.6, Other L20: multiple birth, some ... L21: * 【5†OB and Newborn Coding Guidelines Differ - Elite L22: Learning†www.elitelearning.com】 An outcome of delivery code, V27.0-V27.9 should L23: be included on every maternal record when a delivery has occurred. They are used L24: once on the ... L25: * 【6†[PDF] Appendix 1. Select Codes with Descriptions - CDC L26: Stacks†stacks.cdc.gov】 ICD-9 Code. CPT Code. DRG Code. Outcome of Delivery* V27. L27: Mode of Delivery + complication*. 650 (normal delivery) 59409, 59612. (vaginal L28: delivery). Version 24 ... L29: * 【7†[PDF] ICD-9 and ICD-10 Codes for Outcome of Delivery - Pregnancies†mchp- L30: appserv.cpe.umanitoba.ca】 ICD-9 and ICD-10 Codes for Outcome of Delivery - L31: Pregnancies. Mother's ... V270 OUTCOME OF DELVRY -SINGLE LIVEBORN. Z370. Z37.0 : L32: Single live birth. V271. L33: * 【8†ICD-9-CM Diagnosis Codes V27.* : Outcome of delivery†www.icd9data.com】 L34: V27 Outcome of delivery ; V27.0 Outcome of delivery, single liveborn convert L35: V27.0 to ICD-10-CM ; V27.1 Outcome of delivery, single stillborn convert V27.1 L36: to ICD ...
Step 44
Assistant Message
I notice the CCS label mentioned is "Outcome of delivery (V codes)" which might be different from "Liveborn." Let me check:
browser browser.open
id 5
loc 108
num_lines 10
Tool Response1,057 chars
[9] OB and Newborn Coding Guidelines Differ | Elite Learning (https://www.elitelearning.com/resource-center/health-information-professionals/ob-and-newborn-coding-guidelines-differ/) **viewing lines [108 - 117] of 204** L108: patient (Coding Clinic, Nov-Dec, 1986 pp. 11-12). As a general rule, all L109: clinically significant conditions noted on routine newborn examination should be L110: coded. A condition is clinically significant if it requires the following: L111: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or L112: extended length of hospital stay; or inc…
[9] OB and Newborn Coding Guidelines Differ | Elite Learning (https://www.elitelearning.com/resource-center/health-information-professionals/ob-and-newborn-coding-guidelines-differ/) **viewing lines [108 - 117] of 204** L108: patient (Coding Clinic, Nov-Dec, 1986 pp. 11-12). As a general rule, all L109: clinically significant conditions noted on routine newborn examination should be L110: coded. A condition is clinically significant if it requires the following: L111: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or L112: extended length of hospital stay; or increased nursing care and/or monitoring; L113: or has implications for future health care needs. (This final requirement is an L114: exception to the general guidelines for coding secondary diagnoses on inpatient L115: cases.) 6.1 Assign a code from categories V30-V39 when coding the birth of an L116: infant as principal diagnosis. It is assigned only once to a newborn, at the L117: time of birth only. If the newborn has been transferred from another
Step 45
ehr ehr.get_candidates_by_keyword
table_name diagnoses_ccs_candidates
keyword Outcome of delivery
Tool Response98 chars
No records found in table 'diagnoses_ccs_candidates' containing the keyword 'Outcome of delivery'.
Step 46
ehr ehr.think
response
The CCS categories from AHRQ list: - CCS 218 is "Liveborn" - this is for newborn records (V30-V39 codes) - V27 codes (outcome of delivery) might map to CCS 196 "Other pregnancy and delivery including normal" Looking at the AHRQ PDF, I see that CCS 218 is "Liveborn" and it's in the perinatal section. V27 is "Outcome of delivery" and would likely be categorized differently - possibly within the "Other pregnancy and delivery including normal" category (CCS 196). So for the mother's record, the relevant diagnosis codes would include: - V27.0 (outcome of delivery, single liveborn) - this would likely map to CCS 196 or possibly a separate category Let me reconsider my diagnosis list. The "Liveborn" CCS category (218) is for newborn diagnosis codes (V30-V39), not for the mother. So I should remove "Liveborn" from my list for the mother's diagnoses. Final list of plausible diagnoses for this patient's current admission: 1. Other pregnancy and delivery including normal - Primary diagnosis (vaginal delivery) 2. Deficiency and other anemia - Iron deficiency anemia (microcytic, Hgb 10.3) 3. Thyroid disorders - Hypothyroidism (on levothyroxine) 4. Mood disorders - Depression (on sertraline) 5. Disorders of lipid metabolism - Hyperlipidemia (elevated cholesterol) 6. Late effects of cerebrovascular disease - History of stroke/CVA 7. Other complications of pregnancy - Advanced maternal age (elderly multigravida) 8. Esophageal disorders - GERD (on pantoprazole/ranitidine) Wait, I should also check if there's anything about the Liveborn being used as V27 outcome code on the mother's record. Looking at the CCS PDF search, result [3] mentions "Outcome of delivery (V codes)" as a separate CCS category. But in the candidate table, it appears as "Liveborn." Let me check if V27 maps to the same CCS category. Actually, looking more carefully at the CCS full labels PDF, I can see: - CCS 196: "Other pregnancy and delivery including normal" - CCS 218: "Liveborn" The V27 codes may map to CCS 196 (Other pregnancy and delivery including normal) since they're V supplementary codes related to pregnancy outcome, not perinatal codes. Let me also consider if there are other diagnoses I'm missing. The patient had: - Calcium carbonate (calcium supplement) - Simethicone (gas) - Docusate, bisacodyl, milk of magnesia (constipation - common postpartum) - Dibucaine (hemorrhoid/perineal ointment - suggests perineal trauma/hemorrhoids) The dibucaine suggests possible perineal laceration or hemorrhoids. This could map to: - "OB-related trauma to perineum and vulva" (CCS 193) - if there was a perineal laceration during delivery - Or just hemorrhoid management Since this is an assisted vaginal delivery and they're using dibucaine (topical anesthetic), it's plausible there was some perineal trauma. Let me also consider: - Codeine and oxycodone for pain management is standard postpartum - Oxytocin IV drip for postpartum uterine contraction I think my list is quite comprehensive. Let me finalize it.
Tool Response15 chars
Thinking Finish
Step 47
ehr ehr.get_candidates_by_semantic_similarity
table_name diagnoses_ccs_candidates
query
[ "OB-related trauma perineum vulva laceration delivery", "elderly multigravida advanced maternal age" ]
Tool Response1,098 chars
--- Semantic search results for 'OB-related trauma perineum vulva laceration delivery' ---
Found 5 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
66424 9 OB-related trauma to perineum and vulva 0.836
P156 10 Birth trauma 0.650
N812 10 Prolapse of female genital organs 0…--- Semantic search results for 'OB-related trauma perineum vulva laceration delivery' ---
Found 5 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
66424 9 OB-related trauma to perineum and vulva 0.836
P156 10 Birth trauma 0.650
N812 10 Prolapse of female genital organs 0.548
S28212D 10 Open wounds of head; neck; and trunk 0.518
O9883 10 Other complications of birth; puerperium affecting management of mother 0.500
--- Semantic search results for 'elderly multigravida advanced maternal age' ---
Found 1 unique candidate names (threshold: 0.5, limit: 5)
icd_code icd_version candidate semantic_similarity
25631 9 Menopausal disorders 0.515Step 48
browser browser.search
query ICD-9 659.61 elderly multigravida CCS single level category mapping
Tool Response2,687 chars
[10] ICD-9 659.61 elderly multigravida CCS single level category mapping (web-search://ts=1776350213) **viewing lines [0 - 38] of 38** L0: L1: URL: web-search://ts=1776350213 L2: # Search Results L3: L4: * 【0†ICD-9 Code 659.61 -Elderly multigravida, delivered with or without L5: ...†www.aapc.com】 ICD-9 code 659.61 for Elderly multigravida, delivered with or L6: without mention of antepartum condition is a medical classification as listed by L7: WHO under the ... L8: * 【1†ICD-9-CM Diagnosis Code 659.61 : Elderly multigravida, delivered L9: ...†www.icd9data.com】 659.61 is only applica…
[10] ICD-9 659.61 elderly multigravida CCS single level category mapping (web-search://ts=1776350213) **viewing lines [0 - 38] of 38** L0: L1: URL: web-search://ts=1776350213 L2: # Search Results L3: L4: * 【0†ICD-9 Code 659.61 -Elderly multigravida, delivered with or without L5: ...†www.aapc.com】 ICD-9 code 659.61 for Elderly multigravida, delivered with or L6: without mention of antepartum condition is a medical classification as listed by L7: WHO under the ... L8: * 【1†ICD-9-CM Diagnosis Code 659.61 : Elderly multigravida, delivered L9: ...†www.icd9data.com】 659.61 is only applicable to maternity patients aged 12 - L10: 55 years inclusive. · 659.61 is only applicable to female patients. L11: * 【2†Clinical Classifications Software (CCS) for ICD-9-CM†hcup-us.ahrq.gov】 L12: The CCS now includes categories from the Clinical Classifications Software for L13: Mental Health and Substance Abuse (CCS-MHSA). These categories ... L14: * 【3†[PDF] I C D - 9 Grouping Reference - DHCS†www.dhcs.ca.gov】 ICD-9 Grouping L15: Reference. ICD-9 Code with Decimals. Short Description. Long Description with L16: ICD-9 codes with Decimal. DX Group. DX SubGroup. L17: * 【4†Table 9, ICD-9-CM diagnosis and CCS codes defining coexisting L18: ...†www.ncbi.nlm.nih.gov】 ICD-9-CM diagnosis code or CCS category, Description, L19: Condition. 648.2, Anemia, Anemia. 280, Iron deficiency anemias. 281, Other L20: deficiency anemias. L21: * 【5†Clinical Classifications Software (CCS) for L22: ICD9/10-CM†jackwasey.github.io】 The software contains two different mappings. L23: One is a single level mapping and one is a multi level classification. This data L24: set contains the numeric ... L25: * 【6†ICD-10 O09.521 Conversion to ICD-9 659.61 - ICD List†icdlist.com】 The L26: equivalent for ICD-10 O09.521 is ICD-9 659.61 using the latest General L27: Equivalence Mappings (GEMs) for accurate medical coding. L28: * 【7†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 MULTI-LEVEL. L29: CCS. DIAGNOSIS. CATEGORIES. MULTI-LEVEL CCS DIAGNOSIS CATEGORY LABELS. [Single- L30: Level CCS Diagnosis Category]. 1. Infectious and parasitic diseases. L31: * 【8†[PDF] CCS Category Names (Full Labels) - New Health L32: Analytics†newhealthanalytics.com】 SINGLE-LEVEL. CCS. DIAGNOSIS. CATEGORIES L33: SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2. Septicemia L34: (except in labor). L35: * 【9†[PDF] Clinical Classifications Software (CCS) Code List - IBIS-PH L36: -†ibis.utah.gov】 CCS is a tool for clustering patient diagnoses and procedures L37: into a manageable number of clinically meaningful categories developed at the L38: Agency for ...
Step 49
browser browser.open
id 9
Tool Response4,180 chars
[11] ibis.utah.gov (https://ibis.utah.gov/ibisph-view/pdf/resource/CCS.pdf) **viewing lines [0 - 49] of 259** L0: L1: URL: https://ibis.utah.gov/ibisph-view/pdf/resource/CCS.pdf L2: Services Agencies Search Utah.gov Clinical Classifications Software (CCS) CCS is L3: a tool for clustering patient diagnoses and procedures into a manageable number L4: of clinically meaningful categories developed at the Agency for Healthcare L5: Research and Quality (AHRQ, formerly known as the Agency for Health Care Policy L6: and Research). CCS is used for grouping conditions and procedures without having…
[11] ibis.utah.gov (https://ibis.utah.gov/ibisph-view/pdf/resource/CCS.pdf) **viewing lines [0 - 49] of 259** L0: L1: URL: https://ibis.utah.gov/ibisph-view/pdf/resource/CCS.pdf L2: Services Agencies Search Utah.gov Clinical Classifications Software (CCS) CCS is L3: a tool for clustering patient diagnoses and procedures into a manageable number L4: of clinically meaningful categories developed at the Agency for Healthcare L5: Research and Quality (AHRQ, formerly known as the Agency for Health Care Policy L6: and Research). CCS is used for grouping conditions and procedures without having L7: to wade through thousands of codes. This "clinical grouper" makes it easier to L8: quickly understand patterns of diagnoses and procedures so that health plans, L9: policymakers, and researchers can analyze costs, utilization, and outcomes L10: associated with particular illnesses and procedures. CCS collapses diagnosis and L11: procedure codes from the International Classification of Diseases, 9th L12: Revision, Clinical Modification (IDC-9-CM), which contains over 12,000 diagnosis L13: codes and 3,500 procedure codes. Without CCS, the large number of ICD-9-CM L14: codes poses difficulties in statistical analysis and reporting. (See L15: http://www.hcup- us.ahrq.gov/toolssoftware/ccs/ccsfactsheet.jsp#what) Code List L16: (last updated September 2005) CCS Diagnosis Codes CCS Procedure Codes CCS CCS L17: Definition Definition Code Code 0 No diagnosis 0 No procedure 1 Tuberculosis 1 L18: Incision and excision of CNS Insertion, replacement, or removal of extracranial L19: 2 Septicemia (except in labor) 2 ventricular shunt 3 Bacterial infection, L20: unspecified site 3 Laminectomy, excision intervertebral disc 4 Mycoses 4 L21: Diagnostic spinal tap Insertion of catheter or spinal stimulator and injection L22: into 5 HIV infection 5 spinal canal 6 Hepatitis 6 Decompression peripheral nerve L23: 7 Viral infection 7 Other diagnostic nervous system procedures Other non-OR or L24: closed therapeutic nervous system 8 Other infections, including parasiticn 8 L25: procedures Sexually transmitted infections (not HIV or 9 9 Other OR therapeutic L26: nervous system procedures hepatitis) Immunizations and screening for infectious L27: 10 10 Thyroidectomy, partial or complete disease 11 Cancer of head and neck 11 L28: Diagnostic endocrine procedures 12 Cancer of esophagus 12 Other therapeutic L29: endocrine procedures 13 Cancer of stomach 13 Corneal transplant 14 Cancer of L30: colon 14 Glaucoma procedures �15 Cancer of rectum and anus 15 Lens and cataract L31: procedures 16 Cancer of liver and intrahepatic bile duct 16 Repair of retinal L32: tear, detachment 17 Cancer of pancreas 17 Destruction of lesion of retina and L33: choroid 18 Cancer of other GI organs, peritoneum 18 Diagnostic procedures on eye L34: 19 Cancer of bronchus, lung< 19 Other therapeutic procedures on eyelids, L35: conjunctiva, cornea 20 Cancer, other respiratory and intra thoracic 20 Other L36: intraocular therapeutic procedures 21 Cancer of bone and connective tissue 21 L37: Other extraocular muscle and orbit therapeutic procedures 22 Melanomas of skin L38: 22 Tympanoplasty 23 Other non-epithelial cancer of skin 23 Myringotomy 24 Cancer L39: of breast 24 Mastoidectomy 25 Cancer of uterus 25 Diagnostic procedures on ear L40: 26 Cancer of cervix 26 Other therapeutic ear procedures 27 Cancer of ovary 27 L41: Control of epistaxis 28 Cancer of other female genital organs 28 Plastic L42: procedures on nose 29 Cancer of prostate 29 Dental procedures 30 Cancer of L43: testis 30 Tonsillectomy and/or adenoidectomy 31 Cancer of other male genital L44: organs 31 Diagnostic procedures on nose, mouth and pharynx Other non-OR L45: therapeutic procedures on nose, mouth and 32 Cancer of bladder 32 pharynx Other L46: OR therapeutic procedures on nose, mouth and 33 Cancer of kidney and renal L47: pelvis 33 pharynx 34 Cancer of other urinary organs 34 Tracheostomy, temporary L48: and permanent 35 Cancer of brain and nervous system 35 Tracheoscopy and L49: laryngoscopy with biopsy 36 Cancer of thyroid 36 Lobectomy or pneumonectomy 37
Step 50
browser browser.find
pattern 659.6
cursor 11
Tool Response205 chars
[12] Find results for text: `659.6` in `ibis.utah.gov` (https://ibis.utah.gov/ibisph-view/pdf/resource/CCS.pdf/find?pattern=659.6) **viewing lines [0 - 0] of 0** L0: No `find` results for pattern: `659.6`
Step 51
browser browser.find
pattern 196
cursor 11
Tool Response506 chars
[13] Find results for text: `196` in `ibis.utah.gov` (https://ibis.utah.gov/ibisph-view/pdf/resource/CCS.pdf/find?pattern=196) **viewing lines [0 - 4] of 4** L0: # 【0†match at L209】 L1: Other complications of birth 195 Diagnostic ultrasound of urinary tract 196 L2: Normal pregnancy and/or delivery 196 Diagnostic ultrasound of abdomen or L3: retroperitoneum 197 Skin and subcutaneous tissue infections 197 Other diagnostic L4: ultrasound 198 Other inflammatory condition of skin 198 Magnetic resonance
Step 52
browser browser.search
query CCS single level ICD-9 659 mapping category 196 normal pregnancy delivery elderly multigravida
Tool Response2,834 chars
[14] CCS single level ICD-9 659 mapping category 196 normal pregnancy delivery elderly multigravida (web-search://ts=1776350236) **viewing lines [0 - 40] of 40** L0: L1: URL: web-search://ts=1776350236 L2: # Search Results L3: L4: * 【0†ICD-9 Code 659.61 -Elderly multigravida, delivered with or without L5: ...†www.aapc.com】 ICD-9 code 659.61 for Elderly multigravida, delivered with or L6: without mention of antepartum condition is a medical classification as listed by L7: WHO under the ... L8: * 【1†ICD-9-CM Diagnosis Code 659.61 : Elderly multigravida, delivered L9: ...†www.icd9data.…
[14] CCS single level ICD-9 659 mapping category 196 normal pregnancy delivery elderly multigravida (web-search://ts=1776350236) **viewing lines [0 - 40] of 40** L0: L1: URL: web-search://ts=1776350236 L2: # Search Results L3: L4: * 【0†ICD-9 Code 659.61 -Elderly multigravida, delivered with or without L5: ...†www.aapc.com】 ICD-9 code 659.61 for Elderly multigravida, delivered with or L6: without mention of antepartum condition is a medical classification as listed by L7: WHO under the ... L8: * 【1†ICD-9-CM Diagnosis Code 659.61 : Elderly multigravida, delivered L9: ...†www.icd9data.com】 659.61 is only applicable to maternity patients aged 12 - L10: 55 years inclusive. · 659.61 is only applicable to female patients. L11: * 【2†Elderly multigravida, antepartum condition or complication L12: (659.63)†www.aapc.com】 ICD-9 code 659.63 for Elderly multigravida, antepartum L13: condition or complication is a medical classification as listed by WHO under the L14: range -NORMAL DELIVERY. L15: * 【3†[PDF] Table e-1. ICD-9-CM diagnosis codes for pregnancy and delivery†cdn- L16: links.lww.com】 Normal delivery, and other indications for care in pregnancy, L17: labor, and ... Supervision of high-risk pregnancy with elderly multigravida. L18: V23.83. L19: * 【4†[PDF] CCS Category Names (Full Labels)†hcup-us.ahrq.gov】 CATEGORIES L20: SINGLE-LEVEL CCS DIAGNOSIS CATEGORY LABELS. 1. Tuberculosis. 2 ... Normal L21: pregnancy and/or delivery [196]. 11.7.1. Normal delivery. 11.7.2. L22: * 【5†List of ICD-9 codes 630–679: complications of pregnancy, childbirth L23: ...†en.wikipedia.org】 Normal delivery, and other indications for care in L24: pregnancy, labor, and delivery (650–659) · 659.1 Induction of labor, failed · L25: 659.7 Abnormality in fetal heart ... L26: * 【6†Table 9, ICD-9-CM diagnosis and CCS codes defining coexisting L27: ...†www.ncbi.nlm.nih.gov】 ICD-9-CM diagnosis and CCS codes defining coexisting L28: conditions at delivery. From: Statistical Brief #222, Delivery Hospitalizations L29: Involving Preeclampsia and ... L30: * 【7†659.60 Elderly multigravida-uns - ICD-9-CM Vol. 1 Diagnostic L31: Codes†www.findacode.com】 ICD-9-CM Vol. 1 Diagnostic Codes. 659.60 - Elderly L32: multigravida, unspecified as to episode of care or not applicable ... L33: * 【8†ICD-9-CM Diagnosis Code 659.6 : Elderly multigravida†www.icd9data.com】 L34: Free, official info about 2015 ICD-9-CM diagnosis code 659.6. Includes coding L35: notes, detailed descriptions, index cross-references and ICD-10-CM conversion L36: ... L37: * 【9†Complications of Pregnancy, Childbirth, and the Puerperium: (ICD-9 L38: ...†basicmedicalkey.com】 Complications Mainly Related to Pregnancy. 650-659, L39: Normal Delivery, and Other Indications for Care in Pregnancy, Labor, and L40: Delivery. 660-669 ...
Step 53
ehr ehr.think
response
Based on the ICD-9 code range 650-659 being classified as "Normal delivery, and other indications for care in pregnancy, labor, and delivery," ICD-9 659.61 (elderly multigravida) would map to CCS 196 "Other pregnancy and delivery including normal." So advanced maternal age isn't separately coded as "Other complications of pregnancy" (CCS 181) but rather falls under CCS 196. However, for our purpose, the patient could still have "Other complications of pregnancy" (CCS 181) coded if there are other pregnancy complications. With her history of stroke, she might have high-risk pregnancy supervision which could be coded as complications. Let me finalize my diagnosis list. The key diagnoses for this current admission would be: Primary: 1. Other pregnancy and delivery including normal (CCS 196) - vaginal delivery Secondary/comorbid: 2. Deficiency and other anemia (CCS 59) - iron deficiency anemia (microcytic, Hgb 10.3) 3. Thyroid disorders (CCS 48) - hypothyroidism 4. Mood disorders (CCS 657) - depression 5. Disorders of lipid metabolism (CCS 53) - hyperlipidemia 6. Late effects of cerebrovascular disease (CCS 109) - history of stroke 7. Esophageal disorders (CCS 140) - GERD 8. Other complications of pregnancy (CCS 181) - possible high-risk pregnancy factors 9. Liveborn (CCS 218) - V27 outcome of delivery code on mother's record Actually, wait - the "Liveborn" CCS (218) includes V30-V39 codes which are for NEWBORN records. V27 codes (outcome of delivery) on the MOTHER's record map to CCS 196. So I should not include "Liveborn" for the mother. Let me reconsider OB-related trauma. The use of dibucaine (topical anesthetic for perineum) and the fact that it was an "other manually assisted delivery" suggests possible perineal trauma. This could support CCS 193 "OB-related trauma to perineum and vulva." Final list: 1. Other pregnancy and delivery including normal 2. Deficiency and other anemia 3. Thyroid disorders 4. Mood disorders 5. Disorders of lipid metabolism 6. Late effects of cerebrovascular disease 7. Esophageal disorders 8. OB-related trauma to perineum and vulva (plausible given dibucaine use and assisted delivery) 9. Other complications of pregnancy (advanced maternal age, history of stroke during pregnancy)
Tool Response15 chars
Thinking Finish
Step 54
ehr ehr.finish
response
[ "Other pregnancy and delivery including normal", "Deficiency and other anemia", "Thyroid disorders", "Mood disorders", "Disorders of lipid metabolism", "Late effects of cerebrovascular disease", "Esophageal disorders", "OB-related trauma to perineum and vulva", "Other complications of pregnancy" ]
Tool Response6 chars
Finish
