308 lines
8.7 KiB
JSON
308 lines
8.7 KiB
JSON
{
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"source_file": "CRO 23130006.pdf",
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"document_type": "crh",
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"sejour": {
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"sexe": "F"
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},
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"diagnostic_principal": {
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"texte": "Goitre toxique multinodulaire",
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"cim10_suggestion": "E05.2",
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"cim10_confidence": "high",
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"cim10_final": "E05.2",
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"sources_rag": [],
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"preuves_cliniques": [],
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"est_cma": true,
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"niveau_severite": "non_evalue",
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"niveau_cma": 3,
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"source": "nuke3"
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},
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"dp_selection": {
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"chosen_index": 1,
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"chosen_term": "Goitre toxique multinodulaire",
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"chosen_code": "E05.2",
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"confidence": "high",
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"verdict": "CONFIRMED",
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"evidence": [
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"Le contexte clinique suggère une hyperthyroïdie associée à un goitre multinodulaire.",
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"Le terme 'toxique' indique une production excessive d'hormones thyroïdiennes, ce qui est un élément clé du motif de prise en charge."
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],
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"reason": "Goitre toxique multinodulaire est le diagnostic le plus précis car il combine la morphologie (multinodulaire) et la fonction (toxique/hyperthyroïdienne) du goitre, reflétant le motif principal de prise en charge.",
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"candidates": [
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{
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"index": 0,
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"term": "Goitre multinodulaire",
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"code": "E04.2",
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"confidence": "high",
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"source": "edsnlp",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 2,
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"num_occurrences": 1,
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"score": 5.0,
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"score_details": {
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"section": 2,
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"confidence": 3
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}
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},
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{
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"index": 1,
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"term": "Goitre toxique multinodulaire",
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"code": "E05.2",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 2,
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"score": 5.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 1
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}
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},
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{
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"index": 2,
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"term": "Hyperthyroïdie",
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"code": "E05",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 2,
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"score": 5.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 1
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}
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}
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],
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"debug_scores": {
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"top1": 5.0,
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"top2": 5.0,
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"delta": 0.0,
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"llm": true
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}
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},
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"dp_crh_only": {
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"chosen_index": 1,
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"chosen_term": "Goitre toxique multinodulaire",
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"chosen_code": "E05.2",
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"confidence": "high",
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"verdict": "CONFIRMED",
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"evidence": [
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"Le contexte clinique suggère une hyperthyroïdie associée à un goitre multinodulaire.",
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"Le terme 'toxique' indique une production excessive d'hormones thyroïdiennes, ce qui est un élément clé du motif de prise en charge."
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],
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"reason": "Goitre toxique multinodulaire est le diagnostic le plus précis car il combine la morphologie (multinodulaire) et la fonction (toxique/hyperthyroïdienne) du goitre, reflétant le motif principal de prise en charge.",
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"candidates": [
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{
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"index": 0,
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"term": "Goitre multinodulaire",
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"code": "E04.2",
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"confidence": "high",
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"source": "edsnlp",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 2,
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"num_occurrences": 1,
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"score": 5.0,
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"score_details": {
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"section": 2,
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"confidence": 3
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}
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},
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{
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"index": 1,
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"term": "Goitre toxique multinodulaire",
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"code": "E05.2",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 2,
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"score": 5.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 1
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}
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},
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{
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"index": 2,
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"term": "Hyperthyroïdie",
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"code": "E05",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 2,
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"score": 5.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 1
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}
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}
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],
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"debug_scores": {
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"top1": 5.0,
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"top2": 5.0,
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"delta": 0.0,
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"llm": true
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}
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},
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"dp_final": {
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"chosen_index": 1,
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"chosen_term": "Goitre toxique multinodulaire",
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"chosen_code": "E05.2",
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"confidence": "high",
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"verdict": "CONFIRMED",
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"evidence": [
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"Le contexte clinique suggère une hyperthyroïdie associée à un goitre multinodulaire.",
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"Le terme 'toxique' indique une production excessive d'hormones thyroïdiennes, ce qui est un élément clé du motif de prise en charge."
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],
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"reason": "Goitre toxique multinodulaire est le diagnostic le plus précis car il combine la morphologie (multinodulaire) et la fonction (toxique/hyperthyroïdienne) du goitre, reflétant le motif principal de prise en charge.",
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"candidates": [
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{
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"index": 0,
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"term": "Goitre multinodulaire",
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"code": "E04.2",
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"confidence": "high",
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"source": "edsnlp",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 2,
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"num_occurrences": 1,
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"score": 5.0,
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"score_details": {
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"section": 2,
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"confidence": 3
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}
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},
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{
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"index": 1,
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"term": "Goitre toxique multinodulaire",
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"code": "E05.2",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 2,
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"score": 5.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 1
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}
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},
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{
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"index": 2,
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"term": "Hyperthyroïdie",
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"code": "E05",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 2,
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"score": 5.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 1
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}
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}
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],
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"debug_scores": {
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"top1": 5.0,
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"top2": 5.0,
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"delta": 0.0,
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"llm": true
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}
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},
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"quality_flags": {
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"crh_only_mode": true
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},
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"diagnostics_associes": [],
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"actes_ccam": [],
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"antecedents": [],
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"traitements_sortie": [],
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"biologie_cle": [],
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"biologie_discarded": [],
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"imagerie": [],
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"complications": [],
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"alertes_codage": [
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"CMA niveau 3 : 'Goitre toxique multinodulaire' (E05.2) — sévérité non_evalue",
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"QC: L'absence de justification clinique pour le code E05.2 est un point critique. Veuillez vérifier le dossier clinique pour identifier la pathologie thyroïdienne exacte et justifier le codage en conséquence. Sans justification, le codage est incorrect et peut entraîner un rejet de la part de l'organisme payeur.",
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"VETOS[PDF]: FAIL (score=40)",
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"VETO-02 [HARD] diagnostic_principal: DP E05.2 sans preuve exploitable",
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"VETO-12 [HARD] diagnostic_principal: DP E05.2 en high sans preuve"
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],
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"source_files": [],
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"ghm_estimation": {
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"cmd": "10",
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"cmd_libelle": "Maladies endocriniennes",
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"type_ghm": "M",
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"severite": 1,
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"ghm_approx": "10M??1",
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"cma_count": 0,
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"cms_count": 0,
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"alertes": []
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},
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"controles_cpam": [],
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"veto_report": {
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"verdict": "FAIL",
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"score_contestabilite": 40,
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"issues": [
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{
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"veto": "VETO-02",
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"severity": "HARD",
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"where": "diagnostic_principal",
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"message": "DP E05.2 sans preuve exploitable"
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},
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{
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"veto": "VETO-12",
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"severity": "HARD",
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"where": "diagnostic_principal",
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"message": "DP E05.2 en high sans preuve"
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}
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]
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},
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"processing_time_s": 47.5,
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"metrics": {
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"das_total": 0,
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"das_active": 0,
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"das_excluded": 0,
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"das_removed": 0,
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"das_ruled_out": 0,
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"das_no_code": 0,
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"actes_total": 0,
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"actes_with_code": 0,
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"dp_has_code": true
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},
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"rules_runtime": {
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"router_version": 1,
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"mode": "strict",
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"enabled_packs": [
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"decisions_core",
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"vetos_core"
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],
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"always_on_rules": [],
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"triggers_fired": []
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}
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} |