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-00059

Nadia Foxhall: Obesity

ENC-00059 · 46F · Cardiology · admitted Wed Nov 04, 2026 09:04 AM · discharged Mon Nov 09, 2026 01:05 PM · attending Dr. Odette Galloway · resident Dr. Camila Oyelaran

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 2 (E66.812).

Documented vs supported

Documented: “obesity” · E66.9 Obesity, unspecified
Criteria support: Obesity, class 2 · E66.812 Obesity, class 2
Outcome: BMI 36.2 (class 2)
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 -> E66.812
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 293 Heart failure and shock without CC/MCC → 293 Heart failure and shock without CC/MCC
Relative weight: 0.5660 → 0.5660 (+0.0000)
Codes before: I50.33, E66.9, I10
Codes after: I50.33, I10, E66.812, Z68.36

All open gaps on this encounter together: MS-DRG 293 → 293 (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
BMI from charted height and weight (kg/m2)	36.2	height 154 cm, weight 85.9 kg -> BMI 36.2 · encounter ENC-00059
Age (years)	46	age 46 · encounter ENC-00059

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=46, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=36.2, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=36.2, t.c2=35	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2079); 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-00059   Patient: Nadia Foxhall   To: Dr. Odette Galloway

Clinical indicators from the health record:
- Documented in the record: "obesity" [Progress note DOC-000205]
- height 154 cm, weight 85.9 kg -> BMI 36.2 [encounter ENC-00059]

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

Response options (select one or write your own):
( ) Obesity, class 2 (BMI 35-39.9)
( ) Obesity, class 1 (BMI 30-34.9)
( ) Obesity, class 3 (BMI 40 or higher)
( ) 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

Heart failure · Clinical validation gap Documented “acute on chronic diastolic heart failure” (I50.33) is more specific than the criteria support (Chronic diastolic (HFpEF) heart failure, I50.32).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2079	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00059, ENC-00059.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry d58b06aa4752
1253	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00059, ENC-00059.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 19bb92186c76
511	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00059, ENC-00059.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 0b78ed2b9a2e