{
  "source_file": "CRO 23076325.pdf",
  "document_type": "crh",
  "sejour": {
    "sexe": "M"
  },
  "diagnostic_principal": {
    "texte": "Carcinome urothélial métastatique",
    "cim10_suggestion": "C67.9",
    "cim10_confidence": "low",
    "cim10_final": "C67.9",
    "cim10_decision": {
      "action": "PROMOTE_DP",
      "final_code": "C67.9",
      "reason": "DAS promu en DP (score (2, 1, 4))",
      "needs_info": [],
      "applied_rules": [
        "RULE-DAS-TO-DP"
      ]
    },
    "justification": "Diagnostic oncologique majeur mentionné explicitement comme indication de l'intervention. Le patient est suivi pour cette pathologie qui justifie la pose de néphrostomie. C'est un diagnostic significatif ayant mobilisé des ressources (intervention chirurgicale).",
    "sources_rag": [],
    "preuves_cliniques": [],
    "source": "llm_das",
    "source_page": 1,
    "source_excerpt": "...N-PIERRE ARTIGOLLES\nNé le 20/11/1949\nPOSE DE NEPHROSTOMIE DROITE\nIndication :\nPatient suivi pour un carcinome urothélial métastatique. Dilatation des cavités pyélocalicielles droites symptom\ndouleurs.\nIndication à une pose de néphros..."
  },
  "dp_selection": {
    "chosen_index": 0,
    "chosen_term": "Carcinome urothélial métastatique",
    "chosen_code": "C67.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Carcinome urothélial métastatique",
        "code": "C67.9",
        "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": "Carcinome urothélial métastatique",
    "chosen_code": "C67.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Carcinome urothélial métastatique",
        "code": "C67.9",
        "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": "Carcinome urothélial métastatique",
    "chosen_code": "C67.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Carcinome urothélial métastatique",
        "code": "C67.9",
        "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: ⚠️ ALERTE MAJEURE : Aucune preuve documentée dans le dossier clinique - impossible de valider le codage",
    "QC: ⚠️ Diagnostic métastatique non codé correctement - manque la localisation des métastases",
    "QC: ⚠️ Dossier clinique incomplet - données insuffisantes pour validation PMSI",
    "QC: ⚠️ Justification tronquée et incohérente - à compléter obligatoirement",
    "QC: ⚠️ Absence de diagnostic principal (DP) et diagnostics associés (DA) - codage incomplet",
    "QC: ⚠️ Pas d'acte opératoire codé - si intervention réalisée, doit être documentée",
    "RULE-DAS-TO-DP: DP absent → DAS C67.9 (Carcinome urothélial métastatique) promu en DP",
    "DECISIONS[PDF]: 1 ligne(s)",
    "DECISION: diagnostic_principal C67.9 promu en DP (RULE-DAS-TO-DP)"
  ],
  "source_files": [],
  "ghm_estimation": {
    "cmd": "17",
    "cmd_libelle": "Tumeurs malignes",
    "type_ghm": "M",
    "severite": 1,
    "ghm_approx": "17M??1",
    "cma_count": 0,
    "cms_count": 0,
    "alertes": []
  },
  "controles_cpam": [],
  "veto_report": {
    "verdict": "PASS",
    "score_contestabilite": 100,
    "issues": []
  },
  "completude": {
    "checks": [
      {
        "code": "C67.9",
        "libelle": "Carcinome urothélial métastatique",
        "type_diag": "DP",
        "items": [
          {
            "categorie": "document",
            "element": "ANAPATH",
            "statut": "absent",
            "importance": "obligatoire",
            "impact_cpam": "Compte-rendu anatomopathologique exigé pour tout code C (tumeur maligne)"
          }
        ],
        "score": 30,
        "verdict": "indefendable",
        "resume": "0/1 obligatoires"
      }
    ],
    "score_global": 30,
    "verdict_global": "indefendable",
    "documents_presents": [
      "crh"
    ],
    "documents_manquants": [
      "ANAPATH"
    ]
  },
  "processing_time_s": 14.19,
  "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": []
  }
}