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.

← Back to the worklist · Whole encounter ENC-00005

Gideon Merriweather: Obesity

ENC-00005 · 81M · Hospital Medicine · admitted Tue Nov 10, 2026 01:06 PM · in hospital · attending Dr. Kenji Stavros · resident Dr. Noor Halvorsen

Clinical validation gap Criteria met Open In hospital: concurrent review Resident note awaiting attending cosign

Documented “class 3 obesity” (E66.813) conflicts with what the criteria support (Obesity, class 1, E66.811).

Documented vs supported

Documented: “class 3 obesity” · E66.813 Obesity, class 3
Criteria support: Obesity, class 1 · E66.811 Obesity, class 1
Outcome: BMI 33.8 (class 1)
Rule: Obesity class from BMI v2026.11-1
Published source: CDC: Adult BMI Categories (2024), Class 1: 30 to <35; class 2: 35 to <40; class 3: 40 or higher (adults aged 20 and over) · source (checked 2026-11-14)

Effect if the clinician agrees (illustrative)

Change: E66.813 -> E66.811
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 193 Simple pneumonia and pleurisy with MCC → 193 Simple pneumonia and pleurisy with MCC
Relative weight: 1.3144 → 1.3144 (+0.0000)
Codes before: J18.9, E66.813, N18.32, J96.01, E87.1, E11.9, E78.5
Codes after: J18.9, N18.32, J96.01, E87.1, E11.9, E78.5, E66.811

All open gaps on this encounter together: MS-DRG 193 → 195 (RW -0.6859).

CC/MCC status, CC exclusions (subset) and relative weights from the public CMS FY2026 IPPS final rule tables (5, 6I, 6J, 6K). This is not a grouper and not a payment estimate. Queries never mention any of this.

Severity documentation index change SIMULATED

0.0 points

SIMULATED: Illustrative severity weights (MCC = 1.0, CC = 0.5, non-CC = 0) summed over secondary diagnoses; not a validated risk-adjustment model and not a measured effect.

Evidence

Structured values are read by code from the cited rows. Note facts are shown only when the model's quote was found verbatim in the note.

Evidence (each item cited to a source row or a quoted span)
Input	Value	Source
BMI from charted height and weight (kg/m2)	33.8	height 175 cm, weight 103.6 kg -> BMI 33.8 · encounter ENC-00005
Age (years)	81	age 81 · encounter ENC-00005

Rule trace (inputs, thresholds, outcome)

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=81, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=33.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=33.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=33.8, t.c1=30	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #1969); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: weight-related documentation
Encounter: ENC-00005   Patient: Gideon Merriweather   To: Dr. Kenji Stavros

Clinical indicators from the health record:
- Documented in the record: "class 3 obesity" [Progress note DOC-000017]
- height 175 cm, weight 103.6 kg -> BMI 33.8 [encounter ENC-00005]

Question:
The measurements above are documented in this encounter. Could you clarify the documented weight-related diagnosis?

Response options (select one or write your own):
( ) Class 3 obesity: confirmed (please document the supporting clinical information)
( ) Obesity, class 1 (BMI 30-34.9)
( ) Obesity, class 2 (BMI 35-39.9)
( ) Other explanation of the clinical findings (please specify): ____________
( ) Unable to determine

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.

Other findings on this encounter

Hyponatraemia · Clinical validation gap Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 138).
Acute respiratory failure · Clinical validation gap Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 94%), oxygen no more than 0 L/min, no advanced support.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
1969	2026-11-14T20:57:22	system:llm system	`llm.call`	ENC-00005, ENC-00005.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry f523bfb3ab00
1143	2026-11-14T19:24:27	system:llm system	`llm.call`	ENC-00005, ENC-00005.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry b21a66365561
401	2026-11-14T18:29:03	system:llm system	`llm.call`	ENC-00005, ENC-00005.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry d2bf50345eea