{
  "source_file": "CRO 23092887.pdf",
  "document_type": "crh",
  "sejour": {},
  "diagnostic_principal": {
    "texte": "Éventration sus-ombilicale",
    "cim10_suggestion": "K43.9",
    "cim10_confidence": "medium",
    "cim10_final": "K43.9",
    "cim10_decision": {
      "action": "PROMOTE_DP",
      "final_code": "K43.9",
      "reason": "DAS promu en DP (score (2, 2, 4))",
      "needs_info": [],
      "applied_rules": [
        "RULE-DAS-TO-DP"
      ]
    },
    "justification": "Le compte rendu mentionne explicitement une 'volumineuse éventration' au niveau de la colostomie et une 'éventration sur un ancien orifice d'open-cœlioscopie', nécessitant une fermeture aponévrotique spécifique (5 points de PDS) en plus de la rétablissement de continuité. Cette pathologie a mobilisé des ressources chirurgicales supplémentaires.",
    "sources_rag": [],
    "preuves_cliniques": [],
    "source": "llm_das"
  },
  "dp_selection": {
    "chosen_index": 0,
    "chosen_term": "Éventration sus-ombilicale",
    "chosen_code": "K43.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Éventration sus-ombilicale",
        "code": "K43.9",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 1.0
    }
  },
  "dp_crh_only": {
    "chosen_index": 0,
    "chosen_term": "Éventration sus-ombilicale",
    "chosen_code": "K43.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Éventration sus-ombilicale",
        "code": "K43.9",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 1.0
    }
  },
  "dp_final": {
    "chosen_index": 0,
    "chosen_term": "Éventration sus-ombilicale",
    "chosen_code": "K43.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Éventration sus-ombilicale",
        "code": "K43.9",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 1.0
    }
  },
  "quality_flags": {
    "rag_status": "error",
    "crh_only_mode": true
  },
  "diagnostics_associes": [],
  "actes_ccam": [],
  "antecedents": [],
  "traitements_sortie": [],
  "biologie_cle": [],
  "biologie_discarded": [],
  "imagerie": [],
  "complications": [],
  "alertes_codage": [
    "QUALITE DEGRADEE : erreur RAG — codage sans référentiels",
    "QC: Le dossier clinique n'est pas fourni, ce qui rend l'évaluation complète du codage difficile.  Il est crucial d'avoir accès au dossier clinique pour une validation précise.",
    "QC: L'absence de 'preuves' documentées pour justifier le code est un point faible.  La justification doit se baser sur des éléments précis du dossier.",
    "QC: La description de l'éventration est vague.  Plus de détails sur la localisation, la taille, la présence de complications, et l'historique chirurgical sont nécessaires pour un codage précis.",
    "RULE-DAS-TO-DP: DP absent → DAS K43.9 (Éventration sus-ombilicale) promu en DP",
    "DECISIONS[PDF]: 1 ligne(s)",
    "DECISION: diagnostic_principal K43.9 promu en DP (RULE-DAS-TO-DP)",
    "VETOS[PDF]: NEED_INFO (score=85)",
    "VETO-02 [MEDIUM] diagnostics_associes[0]: DAS K43.9 sans preuve exploitable"
  ],
  "source_files": [],
  "ghm_estimation": {
    "cmd": "06",
    "cmd_libelle": "Affections du tube digestif",
    "type_ghm": "M",
    "severite": 1,
    "ghm_approx": "06M??1",
    "cma_count": 0,
    "cms_count": 0,
    "alertes": []
  },
  "controles_cpam": [],
  "veto_report": {
    "verdict": "NEED_INFO",
    "score_contestabilite": 85,
    "issues": [
      {
        "veto": "VETO-02",
        "severity": "MEDIUM",
        "where": "diagnostics_associes[0]",
        "message": "DAS K43.9 sans preuve exploitable",
        "citation": "Principe de preuve : tout diagnostic/acte doit être étayé par une trace dans le dossier médical (Guide Méthodologique MCO)"
      }
    ]
  },
  "completude": {
    "checks": [],
    "score_global": 100,
    "verdict_global": "defendable",
    "documents_presents": [
      "crh"
    ],
    "documents_manquants": []
  },
  "processing_time_s": 186.22,
  "metrics": {
    "das_total": 0,
    "das_active": 0,
    "das_excluded": 0,
    "das_removed": 0,
    "das_ruled_out": 0,
    "das_no_code": 0,
    "actes_total": 0,
    "actes_with_code": 0,
    "dp_has_code": true
  },
  "rules_runtime": {
    "router_version": 1,
    "mode": "strict",
    "enabled_packs": [
      "decisions_core",
      "vetos_core"
    ],
    "always_on_rules": [],
    "triggers_fired": []
  }
}