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-00056

Nadia Foxhall: Obesity

ENC-00056 · 88F · Pulmonology · admitted Thu Oct 29, 2026 08:39 AM · discharged Fri Nov 06, 2026 12:09 PM · attending Dr. Gideon Zeller · resident Dr. Noor Halvorsen

Specificity gap Criteria met Open Model draft failed the query linter: edit before sending

Documented “obesity” (E66.9); criteria support the more specific Obesity, class 1 (E66.811).

Documented vs supported

Documented: “obesity” · E66.9 Obesity, unspecified
Criteria support: Obesity, class 1 · E66.811 Obesity, class 1
Outcome: BMI 32.3 (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: E66.9 -> E66.811
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 192 Chronic obstructive pulmonary disease without CC/MCC → 192 Chronic obstructive pulmonary disease without CC/MCC
Relative weight: 0.6420 → 0.6420 (+0.0000)
Codes before: J44.1, E66.9
Codes after: J44.1, E66.811, Z68.32

All open gaps on this encounter together: MS-DRG 192 → 191 (RW +0.2010).

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)	32.3	height 155 cm, weight 77.5 kg -> BMI 32.3 · encounter ENC-00056
Age (years)	88	age 88 · encounter ENC-00056

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=88, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=32.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.3, t.c1=30	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2073); clinical indicators and answer options assembled by code from the rule and the record. The model's draft failed the linter (leading, leading, question_form): edit it before sending.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: weight-related documentation
Encounter: ENC-00056   Patient: Nadia Foxhall   To: Dr. Gideon Zeller

Clinical indicators from the health record:
- Documented in the record: "obesity" [Progress note DOC-000195]
- height 155 cm, weight 77.5 kg -> BMI 32.3 [encounter ENC-00056]

Question:
The BMI above meets criteria for obesity; please document the obesity class.

Response options (select one or write your own):
( ) Obesity, class 1 (BMI 30-34.9)
( ) Obesity, class 2 (BMI 35-39.9)
( ) 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 · Specificity gap Criteria support Hyponatraemia (profound) (E87.1); no corresponding diagnosis is documented.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2073	2026-11-14T20:57:23	system:llm system	`llm.call`	ENC-00056, ENC-00056.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 804d45377ef1
1247	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00056, ENC-00056.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 1787757007de
505	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00056, ENC-00056.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 3eb2b65143b5