Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

Pre-cosign check: Progress note DOC-000276

Priya Nakashima · ENC-00080 · written by Dr. Elena Nakashima (resident) · cosigner Dr. Wes Merriweather · status pending

Source document DOC-000276: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Priya Nakashima   MRN: MRN97032309   Hospital day 5

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Chronic systolic heart failure: continue current management.
2. Morbid obesity: counsel on weight.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Elena Nakashima   Attending cosign: pending

Open documentation questions on this encounter (4)

Advisory only. You can cosign now; these stay with the CDI team. They come from the published criteria, not from a model.

Specificity gap Chronic kidney disease: Criteria support Chronic kidney disease stage 3a (N18.31); no corresponding diagnosis is documented.
Evidence and rule trace
Specificity gap Heart failure: Documented “chronic systolic heart failure” (I50.22); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).
Evidence and rule trace
Clinical validation gap Obesity: Documented “morbid obesity” (E66.01) conflicts with what the criteria support (Obesity, class 1, E66.811).
Evidence and rule trace
Clinical validation gap Acute respiratory failure: Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), oxygen no more than 2 L/min, no advanced support.
Evidence and rule trace

Only Dr. Wes Merriweather can cosign. Sign in (demo).