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-00019

Dario Ingram: Obesity

ENC-00019 · 59M · Hospital Medicine · admitted Tue Nov 03, 2026 10:51 AM · discharged Tue Nov 10, 2026 01:37 PM · attending Dr. Gideon Zeller · resident Dr. Keira Upfield

Clinical validation gap Criteria met Open

Documented “morbid obesity” (E66.01) conflicts with what the criteria support (Obesity, class 1, E66.811).

Documented vs supported

Documented: “morbid obesity” · E66.01 Morbid (severe) obesity due to excess calories
Criteria support: Obesity, class 1 · E66.811 Obesity, class 1
Outcome: BMI 33.3 (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: E66.01 -> E66.811
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 377 GI hemorrhage with MCC → 377 GI hemorrhage with MCC
Relative weight: 1.8280 → 1.8280 (+0.0000)
Codes before: K92.2, E66.01, J96.01, D62, E11.9, K21.9, E78.5
Codes after: K92.2, J96.01, D62, E11.9, K21.9, E78.5, E66.811

All open gaps on this encounter together: MS-DRG 377 → 378 (RW -0.8473).

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)	33.3	height 179 cm, weight 106.7 kg -> BMI 33.3 · encounter ENC-00019
Age (years)	59	age 59 · encounter ENC-00019

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=59, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=33.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=33.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=33.3, t.c1=30	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #1990); 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-00019   Patient: Dario Ingram   To: Dr. Gideon Zeller

Clinical indicators from the health record:
- Documented in the record: "morbid obesity" [Progress note DOC-000062]
- height 179 cm, weight 106.7 kg -> BMI 33.3 [encounter ENC-00019]

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):
( ) Morbid 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

Acute blood loss anaemia · Clinical judgement required Clinical judgement required: Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL).
Acute respiratory failure · Clinical validation gap Documented “acute hypoxic respiratory failure” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), 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
1990	2026-11-14T20:57:23	system:llm system	`llm.call`	ENC-00019, ENC-00019.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry ae5083dabcc6
1164	2026-11-14T19:24:28	system:llm system	`llm.call`	ENC-00019, ENC-00019.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry 4370067715c5
422	2026-11-14T18:29:03	system:llm system	`llm.call`	ENC-00019, ENC-00019.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry 2d7465a950c3