One row per condition family: what the record supports under the published definition, what the note states, the
visit's diagnosis entries, and an assessment. Codes are coded from the signed documentation; the software never assigns one.
Draft query: Heart failure type (ejection fraction)
! Blocked by the non-leading wording check
!A query needs a named human sender (sign in).
A non-leading clarification request: clinical indicators with their sources, an open question, several options plus
"other" and "unable to determine". No code and no payment word; the same indicators cannot be queried twice.
Documentation clarification request (draft) · echocardiogram results · visit KE-P33
Title: Clarification request: echocardiogram results
Encounter: KE-P33 Patient: P33 To: author of the draft note
From: (no named sender: sign in to send)
Date: 2026-11-13 Rule versions: front_hf_ef_type@1.0, front-engine 1.2 Check run: FRUN-00033
Clinical indicators from the health record:
- Documented in the record: "Heart failure with reduced ejection fraction" [draft note KN-P33-1, characters 244-288]
- Ejection fraction 48% · echocardiogram 2026-10-13 (transthoracic, biplane): "Left ventricular ejection fraction 48% by biplane method." (Dr. Leopold Nairn (cardiology)) [record item ECHO-P33-2]
- Ejection fraction 30% · echocardiogram 2025-05-21 (transthoracic, biplane): "Left ventricular ejection fraction 30% by biplane method." (Dr. Leopold Nairn (cardiology)) [record item ECHO-P33-1]
Question:
Based on your independent clinical judgement, can the documentation of this condition be clarified in light of the echocardiogram results listed above?
Response options (select one or write your own):
( ) Heart failure with reduced ejection fraction (HFrEF)
( ) Heart failure with mildly reduced ejection fraction (HFmrEF)
( ) Heart failure with preserved ejection fraction (HFpEF)
( ) Heart failure with improved ejection fraction (HFimpEF)
( ) Other (please specify): ____________
( ) Clinically unable to determine
( ) Not clinically supported
Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.
Blocked: A query needs a named human sender (sign in).
Core definitions 2
Core definitions: condition families for this encounter (2)
Condition family
What the record supports
What the note states
Visit diagnosis entries
Assessment
Heart failure type (ejection fraction) judgement tier · side-panel condition
front_hf_ef_type@1.0Draft · pending review
Record meets: Heart failure with mildly reduced ejection fraction (HFmrEF); Heart failure with improved ejection fraction (HFimpEF)
Ejection fraction 48% · echocardiogram 2026-10-13 (transthoracic, biplane): Left ventricular ejection fraction 48% by biplane method.(Dr. Leopold Nairn (cardiology))· ECHO-P33-2
Ejection fraction 30% · echocardiogram 2025-05-21 (transthoracic, biplane): Left ventricular ejection fraction 30% by biplane method.(Dr. Leopold Nairn (cardiology))· ECHO-P33-1
Options and what the record shows
Heart failure with reduced ejection fraction (HFrEF) · needs latest ejection fraction 40% or lower · record: latest 48% on 2026-10-13 · not met
Heart failure with mildly reduced ejection fraction (HFmrEF) · needs latest ejection fraction 41% to 49% · record: latest 48% on 2026-10-13 · met
Heart failure with preserved ejection fraction (HFpEF) · needs latest ejection fraction 50% or higher · record: latest 48% on 2026-10-13 · not met
Heart failure with improved ejection fraction (HFimpEF) · needs an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points · record: earlier 30% on 2025-05-21, latest 48% on 2026-10-13 (change +18 points) · met
Citation
Heart failure type by ejection fraction (four categories, 2021 universal definition as restated in 2022)
front_hf_ef_type@1.0
In our words: Reduced ejection fraction: 40% or lower. Mildly reduced: 41% to 49%. Preserved: 50% or higher. Improved: an earlier ejection fraction of 40% or lower, a later one above 40%, and a rise of at least 10 points. (2021 edition, as restated in an openly licensed 2022 paper.)
HFrEF, LVEF ≤ 40%
Chandramouli C, Stewart S, Almahmeed W, Lam CSP (Clinical Cardiology), Clinical implications of the universal definition for the prevention and treatment of heart failure (2022) ·
Section 1.3 'New universal definition' (classification by left ventricular ejection fraction) · source
Licence: open licence: CC BY 4.0, attribution: Chandramouli C, Stewart S, Almahmeed W, Lam CSP. Clinical implications of the universal definition for the prevention and treatment of heart failure. Clin Cardiol 2022;45(Suppl 1):S2-S12. doi:10.1002/clc.23842. Licensed under CC BY 4.0.. Source checked: opened. No endorsement by the cited bodies is implied.
To confirm with a clinician: the boundary wording at exactly 40%. This file reads reduced as 40% or lower (the openly licensed source); the federal cross-check says below 40%. A reported 40% is shown as reduced.
To confirm with a clinician: the improved-category baseline rule. The baseline is the first earlier ejection fraction of 40% or lower on file and the comparison value is the latest; another reading (lowest earlier value, or the value just before the latest) can give a different answer.
To confirm with a clinician: whether the 2021 categories should stay the shown edition now that a 2026 edition reportedly drops fixed cut-offs between reduced and preserved.
Heart failure with reduced ejection fraction
None entered
● Entered or stated without support in the record
The note says “Heart failure with reduced ejection fraction”; the latest ejection fraction is 48% on 2026-10-13, which does not fit the type written (needs 40% or lower). An earlier value was 30% on 2025-05-21.
Clinician's response to the side-panel card: No response yet · offer OF-000029
Chronic kidney disease stage 1 · needs filtering rate 90 or above with a kidney damage marker (for example albuminuria on two tests at least 90 days apart) · record: filtering rate 60 or above; needs a kidney damage marker (no persistent albuminuria on file) · not assessable
Chronic kidney disease stage 2 · needs filtering rate 60-89 with a kidney damage marker (for example albuminuria on two tests at least 90 days apart) · record: filtering rate 60 or above; needs a kidney damage marker (no persistent albuminuria on file) · not assessable
Chronic kidney disease stage 3a · needs filtering rate 45-59 on two results at least 90 days apart · record: results at least 90 days apart are 60 or above · not met
Chronic kidney disease stage 3b · needs filtering rate 30-44 on two results at least 90 days apart · record: results at least 90 days apart are 60 or above · not met
Chronic kidney disease stage 4 · needs filtering rate 15-29 on two results at least 90 days apart · record: results at least 90 days apart are 60 or above · not met
Chronic kidney disease stage 5 · needs filtering rate below 15 on two results at least 90 days apart · record: results at least 90 days apart are 60 or above · not met
Citation
Kidney disease stage wording by filtering rate, with the albumin-to-creatinine category (options for the clinician)
front_kidney_stage_wording@1.0
In our words: Kidney disease by filtering rate: below 60 on results at least 3 months apart; or urine albumin-to-creatinine ratio 30 mg/g or higher on two tests at least 3 months apart. Stage by filtering rate: G1 90 or above; G2 60-89; G3a 45-59; G3b 30-44; G4 15-29; G5 below 15 (G1 and G2 also need a marker of kidney damage). Albumin-to-creatinine category: A1 below 30, A2 30-299, A3 300 mg/g or above. The filtering rate is estimated with the 2021 race-free creatinine equation.
Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for the Primary Care Management of Chronic Kidney Disease, Provider Summary (Version 5.0) (2025) ·
Sidebar 6 'Criteria for CKD' (PDF page 16; printed page 13 of 37). Do not use Sidebar 9 (a reproduced third-party figure) · source
Licence: U.S. government work (public domain); filtering-rate stage bands (90, 60, 45, 30, 15) and the G3a/G3b split: fact only citation; albumin-to-creatinine categories (A1 below 30, A2 30-299, A3 300 mg/g or above): fact only citation; 2021 creatinine equation: public domain. Source checked: opened. No endorsement by the cited bodies is implied.
To confirm with a clinician: three months is encoded as 90 days (the VA/DoD summary says 3 months or more).
Not stated
None entered
· Nothing to act on
Kidney results 200 days apart are 60 or above (filtering rate 80.4 on 2026-04-26 and 80.4 on 2026-11-12) and the note doesn't mention kidney function.
Clinician's response to the side-panel card: No response yet
Whole code category, for reference (no code is selected, ranked or suggested): Kidney disease stage (filtering rate)ⓘ Coders only
ⓘreference for coders — the clinician's documented statement governs; the software does not assign codes
N18 Chronic kidney disease (CKD) (9 codes in the category).
Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).
Extended capabilities (licence required before commercial use) 0
ⓘExtended capabilities: published criteria cited by title and restated in our own words, no text reproduced; a licence or permission is needed before commercial use.
Shown to coders always; on clinician screens only when the setting is on (now off).