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-00024

Wes Elsworth: Chronic kidney disease

ENC-00024 · 79F · Hospital Medicine · admitted Thu Oct 29, 2026 01:52 PM · discharged Tue Nov 03, 2026 02:48 PM · attending Dr. Gideon Zeller · resident Dr. Noor Halvorsen

Clinical judgement required Clinical judgement required Open

Clinical judgement required: Pre-admission eGFR values fall on both sides of 60.

Documented vs supported

Documented: “CKD stage 3a” · N18.31 Chronic kidney disease, stage 3a
Criteria support: no conclusion: clinical judgement required
Outcome: Pre-admission eGFR values fall on both sides of 60
Rule: Chronic kidney disease stage (eGFR, CKD-EPI 2021) v2026.11-1
Published source: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2024), Chapter 1, Table 1 (definition: abnormality for a minimum of 3 months) and Table 2 (GFR categories) · source (checked 2026-11-14)

Clinical judgement required. The rule does not conclude here. A CDI specialist may send an open query or dismiss the finding; nothing is proposed as fact.

Effect if the clinician agrees (illustrative)

Change: no projected change (clinician judgement)
Secondary-diagnosis level: non-CC → —
MS-DRG (illustrative): 195 Simple pneumonia and pleurisy without CC/MCC → 195 Simple pneumonia and pleurisy without CC/MCC
Relative weight: 0.6285 → 0.6285 (+0.0000)
Codes before: J18.9, E66.812, N18.31
Codes after: J18.9, E66.812, N18.31

All open gaps on this encounter together: MS-DRG 195 → 193 (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
Number of pre-admission eGFR values within 2 years (inpatient values during acute illness are not used)	2	creatinine 1.02 -> eGFR 56 · lab LAB-000812 · 2025-11-18 09:15 creatinine 0.89 -> eGFR 66 · lab LAB-000813 · 2026-07-18 10:05
Days between the earliest and latest pre-admission eGFR values	242	creatinine 1.02 mg/dL -> eGFR 56 (CKD-EPI 2021) · lab LAB-000812 · 2025-11-18 09:15 creatinine 0.89 mg/dL -> eGFR 66 (CKD-EPI 2021) · lab LAB-000813 · 2026-07-18 10:05
Earliest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021)	56.0	creatinine 1.02 mg/dL -> eGFR 56 (CKD-EPI 2021) · lab LAB-000812 · 2025-11-18 09:15
Latest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021)	65.9	creatinine 0.89 mg/dL -> eGFR 66 (CKD-EPI 2021) · lab LAB-000813 · 2026-07-18 10:05

Rule trace (inputs, thresholds, outcome)

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=242, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=56.0, egfr_late=65.9	65.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=56.0, egfr_late=65.9, t.g2=60	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=65.9, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=56.0, egfr_late=65.9, t.g2=60	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #1999); clinical indicators and answer options assembled by code from the rule and the record.

Sign in to act. Sign in as a demo user (a CDI specialist sends queries).

DOCUMENTATION QUERY (draft)
Title: Clarification request: chronic kidney documentation
Encounter: ENC-00024   Patient: Wes Elsworth   To: Dr. Gideon Zeller

Clinical indicators from the health record:
- Documented in the record: "CKD stage 3a" [History and physical DOC-000078]
- creatinine 1.02 -> eGFR 56 (2025-11-18 09:15) [lab LAB-000812]
- creatinine 0.89 -> eGFR 66 (2026-07-18 10:05) [lab LAB-000813]

Question:
Could you review the kidney function indicators above and clarify any related chronic diagnosis, if clinically appropriate?

Response options (select one or write your own):
( ) 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 respiratory failure · Specificity gap Criteria support Acute respiratory failure with hypoxia (J96.01); no corresponding diagnosis is documented.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
1999	2026-11-14T20:57:23	system:llm system	`llm.call`	ENC-00024, ENC-00024.ckd	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt cda6e9b07578 output ba86a1b76b41 entry 44c63e550622
1173	2026-11-14T19:24:28	system:llm system	`llm.call`	ENC-00024, ENC-00024.ckd	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt cda6e9b07578 output ba86a1b76b41 entry e31bf9edb4a3
431	2026-11-14T18:29:03	system:llm system	`llm.call`	ENC-00024, ENC-00024.ckd	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt cda6e9b07578 output ba86a1b76b41 entry 332c05fd5f4d