Patient Identification
ATTN:
DATE:
COACH:
TIME:
Diseases of the Blood & Blood-Forming Organs
DOCUMENTATION CLARIFICATION
Reportable Conditions - defined by CMS Official Coding Guidelines as affecting patient care by requiring:
Clinical evaluation
Therapeutic treatment
Diagnostic procedures
Extended length of hospital stay
Increased nursing care and/or monitoring
Comments:
Treatment/Management:
Documentation of the possible or probable underlying etiology of anemia is required to reflect the appropriate severity
of illness for your patient. Please also document whether the anemia is acute or chronic.
Can the diagnosis be further specified as:
“Acute or chronic
“.
Acute blood loss anemia
Hemolytic anemia
Hg/Hct
/
Date
Drug or therapy related (drop in Hg/Hct)
Hg/Hct
/
Date
Iron deficiency anemia
Hg/Hct
/
Date
Chronic disease (i.e. renal disease)
Unable to be determined
Surgery (drop in Hg/Hct)
Other
Please remember to document in the Progress Notes and Discharge Summary, as this note is NOT part of
the permanent medical record. Please leave this note on the chart.
I disagree, see my comments.
In responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not
imply that any particular answer is desired or expected. We greatly appreciate your clarification on this issue.
This is NOT part of the permanent record, however, PLEASE LEAVE ON THE CHART.
This is a PRIVILEGED and CONFIDENTIAL document, not to be copied or distributed.
#4 Anemia
Rev. 3/2013