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.

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Rosalind Upfield: Pressure injury

ENC-00018 · 89F · Hospital Medicine · admitted Sun Nov 08, 2026 02:09 PM · in hospital · attending Dr. Jalen Carrow · resident Dr. Camila Oyelaran

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

Documented “sacral decubitus ulcer” (L89.159); criteria support the more specific Pressure injury of sacral region, unstageable (L89.150).

Documented vs supported

Documented: “sacral decubitus ulcer” · L89.159 Pressure ulcer of sacral region, unspecified stage
Criteria support: Pressure injury of sacral region, unstageable · L89.150 Pressure ulcer of sacral region, unstageable
Outcome: Wound nurse documents an unstageable injury, sacral
Rule: Pressure injury stage (sacral region) v2026.11-1
Published source: NPIAP Pressure Injury Stages (revised staging system) (2016), Stage 1-4, unstageable, deep tissue pressure injury definitions · source (checked 2026-11-14)

Effect if the clinician agrees (illustrative)

Change: L89.159 -> L89.150
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 872 Septicemia or severe sepsis without MV >96 hours without MCC → 872 Septicemia or severe sepsis without MV >96 hours without MCC
Relative weight: 1.0233 → 1.0233 (+0.0000)
Codes before: A41.9, N39.0, E66.812, N18.9, N17.9, E87.1, D62, L89.159, K21.9, I10, E11.9
Codes after: A41.9, N39.0, E66.812, N18.9, N17.9, E87.1, D62, K21.9, I10, E11.9, L89.150

All open gaps on this encounter together: MS-DRG 872 → 872 (RW +0.0000). The grouping does not change; the record becomes accurate.

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
Stage quoted from the wound-care note	unstageable	“Stage: unstageable” · Wound care note DOC-000058, p. 1, line 5 · quoted span verified Show the quote in the note WOUND CARE NOTE Patient: Rosalind Upfield MRN: MRN70259788 Location: sacrum Stage: unstageable (NPIAP) Description: wound bed obscured by eschar. Size: 3.5 x 2.6 x 0.1 cm. Plan: offloading every 2 hours, foam dressing, nutrition consult.
Site quoted from the wound-care note	sacral	“Location: sacrum” · Wound care note DOC-000058, p. 1, line 4 · quoted span verified Show the quote in the note WOUND CARE NOTE Patient: Rosalind Upfield MRN: MRN70259788 Location: sacrum Stage: unstageable (NPIAP) Description: wound bed obscured by eschar. Size: 3.5 x 2.6 x 0.1 cm. Plan: offloading every 2 hours, foam dressing, nutrition consul …

Rule trace (inputs, thresholds, outcome)

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=sacral	true
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unstageable	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=unstageable	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=unstageable	false
outcome: stage3	`sacral and wound_stage == '3'`	sacral=True, wound_stage=unstageable	false
outcome: stage4	`sacral and wound_stage == '4'`	sacral=True, wound_stage=unstageable	false
outcome: unstageable	`sacral and wound_stage == 'unstageable'`	sacral=True, wound_stage=unstageable	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #1988); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: skin integrity documentation
Encounter: ENC-00018   Patient: Rosalind Upfield   To: Dr. Jalen Carrow

Clinical indicators from the health record:
- Documented in the record: "sacral decubitus ulcer" [Progress note DOC-000060]
- "Stage: unstageable" (2026-11-09 21:09) [Wound care note DOC-000058, p. 1, line 5]
- "Location: sacrum" (2026-11-09 21:09) [Wound care note DOC-000058, p. 1, line 4]

Question:
The wound-care documentation above is part of this encounter. Based on your clinical judgement, can a related diagnosis be documented, including site and stage?

Response options (select one or write your own):
( ) Pressure ulcer of sacral region, unstageable
( ) Other (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

Acute blood loss anaemia · Clinical judgement required Clinical judgement required: Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL).
Chronic kidney disease · Specificity gap Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 4 (N18.4).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
1988	2026-11-14T20:57:23	system:llm system	`llm.call`	ENC-00018, ENC-00018.pressure_injury	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 94204f2cd745 output 29146ed5aa61 entry a5411a118760
1162	2026-11-14T19:24:28	system:llm system	`llm.call`	ENC-00018, ENC-00018.pressure_injury	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 94204f2cd745 output 29146ed5aa61 entry 5aef136300c0
420	2026-11-14T18:29:03	system:llm system	`llm.call`	ENC-00018, ENC-00018.pressure_injury	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 94204f2cd745 output 29146ed5aa61 entry b839e2fc8e1a