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-00042
Marisol Thorne: Chronic kidney disease
ENC-00042 · 84F · Hospital Medicine · admitted Sat Oct 31, 2026 12:25 PM · discharged Wed Nov 04, 2026 01:08 PM · attending Dr. Gideon Zeller · resident Dr. Elena Nakashima
Specificity gap Criteria met Open
Documented “chronic kidney disease” (N18.9); criteria support the more specific Chronic kidney disease stage 3b (N18.32).
Documented vs supported
- Documented
- “chronic kidney disease” · N18.9 Chronic kidney disease, unspecified
- Criteria support
- Chronic kidney disease stage 3b · N18.32 Chronic kidney disease, stage 3b
- Outcome
- Two eGFR values >=90 days apart, both below 60; staging value 34.4 (G3b)
- 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)
Effect if the clinician agrees (illustrative)
- Change
- N18.9 -> N18.32
- Secondary-diagnosis level
- non-CC → non-CC
- MS-DRG (illustrative)
- 194 Simple pneumonia and pleurisy with CC → 194 Simple pneumonia and pleurisy with CC
- Relative weight
- 0.8059 → 0.8059 (+0.0000)
- Codes before
- J18.9, N18.9, E87.1
- Codes after
- J18.9, E87.1, N18.32
All open gaps on this encounter together: MS-DRG 194 → 194 (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.
| Input | Value | Source |
|---|---|---|
| Number of pre-admission eGFR values within 2 years (inpatient values during acute illness are not used) | 2 |
creatinine 1.49 -> eGFR 34
creatinine 1.49 -> eGFR 34
|
| Days between the earliest and latest pre-admission eGFR values | 260 |
creatinine 1.49 mg/dL -> eGFR 34 (CKD-EPI 2021)
creatinine 1.49 mg/dL -> eGFR 34 (CKD-EPI 2021)
|
| Earliest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021) | 34.4 |
creatinine 1.49 mg/dL -> eGFR 34 (CKD-EPI 2021)
|
| Latest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021) | 34.4 |
creatinine 1.49 mg/dL -> eGFR 34 (CKD-EPI 2021)
|
Rule trace (inputs, thresholds, outcome)
| 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=260, t.chronic_days=90 | true |
| derived: staging_egfr | max(egfr_early, egfr_late) |
egfr_early=34.4, egfr_late=34.4 | 34.4 |
| derived: both_below_60 | egfr_early < t.g2 and egfr_late < t.g2 |
egfr_early=34.4, egfr_late=34.4, t.g2=60 | true |
| 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=34.4, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15 | G3b |
| 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=True, egfr_early=34.4, egfr_late=34.4, t.g2=60 | false |
| outcome: g1_g2 | staging_egfr >= t.g2 |
staging_egfr=34.4, t.g2=60 | false |
| outcome: g3a | category == 'G3a' |
category=G3b | false |
| outcome: g3b | category == 'G3b' |
category=G3b | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2038); clinical indicators and answer options assembled by code from the rule and the record.
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DOCUMENTATION QUERY (draft) Title: Clarification request: chronic kidney documentation Encounter: ENC-00042 Patient: Marisol Thorne To: Dr. Gideon Zeller Clinical indicators from the health record: - Documented in the record: "chronic kidney disease" [History and physical DOC-000142] - creatinine 1.49 -> eGFR 34 (2025-11-15 09:15) [lab LAB-001427] - creatinine 1.49 -> eGFR 34 (2026-08-02 10:05) [lab LAB-001428] Question: Based on your clinical judgement and the indicators above, can the chronic kidney condition be further specified, including stage if known? Response options (select one or write your own): ( ) Chronic kidney disease stage 3a (eGFR 45-59) ( ) Chronic kidney disease stage 3b (eGFR 30-44) ( ) Chronic kidney disease stage 4 (eGFR 15-29) ( ) 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 kidney injury · Specificity gap Criteria support Acute kidney injury (KDIGO stage 2) (N17.9); no corresponding diagnosis is documented.
- Hyponatraemia · Clinical judgement required Clinical judgement required: Low sodium without documented treatment or repeat values; clinical significance is a clinician judgement.
- Malnutrition · Specificity gap Criteria support Moderate (non-severe) protein-calorie malnutrition (acute illness context) (E44.0); no corresponding diagnosis is documented.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2038 | 2026-11-14T20:57:23 | system:llm system |
llm.call |
ENC-00042, ENC-00042.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 11b063649446 |
| 1212 | 2026-11-14T19:24:28 | system:llm system |
llm.call |
ENC-00042, ENC-00042.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 1de0279857ad |
| 470 | 2026-11-14T18:29:04 | system:llm system |
llm.call |
ENC-00042, ENC-00042.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry af3a847c9b6e |