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.
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) · kidney filtering-rate results · visit KE-P34
Title: Clarification request: kidney filtering-rate results
Encounter: KE-P34 Patient: P34 To: author of the draft note
From: (no named sender: sign in to send)
Date: 2026-11-13 Rule versions: front_kidney_stage_wording@1.0, front-engine 1.2 Check run: FRUN-00046
Clinical indicators from the health record:
- Documented in the record: "CKD" [draft note KN-P34-1]
- Filtering rate 38.4 on 2026-07-25 (G3b range) and 37.0 on 2026-11-12 (G3b range) [record item L-0078]
- Urine albumin-to-creatinine ratio 165 mg/g on 2026-11-12: A2 range [record item L-0081]
- Urine albumin-to-creatinine ratio 140 mg/g on 2026-07-25: A2 range [record item L-0079]
Question:
Based on your independent clinical judgement, can the documentation be further specified in light of the kidney filtering-rate results listed above?
Response options (select one or write your own):
( ) Chronic kidney disease stage 1
( ) Chronic kidney disease stage 2
( ) Chronic kidney disease stage 3a
( ) Chronic kidney disease stage 3b
( ) Chronic kidney disease stage 4
( ) Chronic kidney disease stage 5
( ) 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 1
Core definitions: condition families for this encounter (1)
Filtering rate 38.4 on 2026-07-25 (G3b range) and 37.0 on 2026-11-12 (G3b range) · L-0078
Urine albumin-to-creatinine ratio 165 mg/g on 2026-11-12: A2 range · L-0081
Urine albumin-to-creatinine ratio 140 mg/g on 2026-07-25: A2 range · L-0079
Albuminuria on two tests at least 90 days apart: yes
Options and what the record shows
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 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range) · not met
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 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range) · not met
Chronic kidney disease stage 3a · needs filtering rate 45-59 on two results at least 90 days apart · record: filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range) · not met
Chronic kidney disease stage 3b · needs filtering rate 30-44 on two results at least 90 days apart · record: filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range) · met
Chronic kidney disease stage 4 · needs filtering rate 15-29 on two results at least 90 days apart · record: filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range) · not met
Chronic kidney disease stage 5 · needs filtering rate below 15 on two results at least 90 days apart · record: filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range) · 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).
CKD
None entered
● Supported, but entered or stated less specifically than the record supports
The note says “CKD”; the note does not give a stage. Two results 110 days apart are in the G3b range (filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12).
Clinician's response to the side-panel card: No response yet · offer OF-000041
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).