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-00068

Yusuf Yardley: Malnutrition

ENC-00068 · 70F · Hospital Medicine · admitted Sat Oct 24, 2026 04:12 PM · discharged Sun Nov 01, 2026 03:00 PM · attending Dr. Wes Merriweather

Specificity gap Criteria met Open

Documented “malnourished” (E46); criteria support the more specific Moderate (non-severe) protein-calorie malnutrition (chronic illness context) (E44.0).

Documented vs supported

Documented: “malnourished” · E46 Unspecified protein-calorie malnutrition
Criteria support: Moderate (non-severe) protein-calorie malnutrition (chronic illness context) · E44.0 Moderate protein-calorie malnutrition
Outcome: 2 moderate-or-worse characteristics, fewer than two severe (chronic illness context)
Rule: Malnutrition severity (ASPEN/Academy 2012 consensus characteristics) v2026.11-1
Published source: Consensus statement: Academy of Nutrition and Dietetics and ASPEN: characteristics recommended for the identification and documentation of adult malnutrition (White JV et al., J Acad Nutr Diet 2012;112:730-738) (2012), Table: clinical characteristics; at least two of six characteristics; acute illness and chronic illness contexts · source (checked 2026-11-14)
Contested: GLIM (2019) is an alternative, internationally endorsed framework with different thresholds; an organization must choose one per policy. This rule encodes ASPEN/Academy 2012 and lists GLIM as the alternative.

Effect if the clinician agrees (illustrative)

Change: E46 -> E44.0
Secondary-diagnosis level: CC → 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, E46, J96.01, D64.9, E11.9
Codes after: K92.2, J96.01, D64.9, E11.9, E44.0

All open gaps on this encounter together: MS-DRG 377 → 377 (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
Context from the dietitian assessment ("acute" or "chronic" illness)	chronic	“setting of chronic illness” · Nutrition assessment DOC-000233, p. 1, line 3 · quoted span verified Show the quote in the note RD follow-up note Pt seen in the setting of chronic illness. Eating about half of meals for the past 5 weeks. Weight 57.3 kg, down from 63.6 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No e …
Subcutaneous fat loss (0 none, 1 mild, 2 moderate, 3 severe)	1	“mild fat loss” · Nutrition assessment DOC-000233, p. 1, line 3 · quoted span verified Show the quote in the note … in the setting of chronic illness. Eating about half of meals for the past 5 weeks. Weight 57.3 kg, down from 63.6 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No edema. Hand grip not assessed. Plan: oral supplement twice daily; recheck weight weekly.
Muscle mass loss (0-3)	1	“Mild temporal wasting” · Nutrition assessment DOC-000233, p. 1, line 3 · quoted span verified Show the quote in the note … follow-up note Pt seen in the setting of chronic illness. Eating about half of meals for the past 5 weeks. Weight 57.3 kg, down from 63.6 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No edema. Hand grip not assessed. Plan: oral supplement twice daily; recheck weight weekly.

Rule trace (inputs, thresholds, outcome)

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_days=unknown, intake_pct=unknown, t.a_sev_intake_days=5, t.a_sev_intake_pct=50	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_days=unknown, intake_pct=unknown, t.a_mod_intake_days=7, t.a_mod_intake_pct=75	unknown
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_days=unknown, intake_pct=unknown, t.c_intake_days=30, t.c_intake_pct=75	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_days=unknown, intake_pct=unknown, t.c_intake_days=30, t.c_intake_pct=75	unknown
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	fat_loss=1, fluid=unknown, grip_reduced=unknown, intake_pct=unknown, muscle_loss=1, wt_loss_pct=unknown	2
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	a_sev_intake=unknown, a_sev_wt=unknown, c_sev_intake=unknown, c_sev_wt=unknown, fat_loss=1, fluid=unknown, grip_reduced=unknown, muscle_loss=1, nutr_context=chronic	0
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	a_mod_intake=unknown, a_mod_wt=unknown, a_sev_intake=unknown, a_sev_wt=unknown, c_mod_intake=unknown, c_mod_wt=unknown, c_sev_intake=unknown, c_sev_wt=unknown, fat_loss=1, fluid=unknown, grip_reduced=unknown, muscle_loss=1, nutr_context=chronic	2
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=2	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2104); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: nutrition documentation
Encounter: ENC-00068   Patient: Yusuf Yardley   To: Dr. Wes Merriweather

Clinical indicators from the health record:
- Documented in the record: "malnourished" [Progress note DOC-000235]
- "setting of chronic illness" (2026-10-25 21:12) [Nutrition assessment DOC-000233, p. 1, line 3]
- "mild fat loss" (2026-10-25 21:12) [Nutrition assessment DOC-000233, p. 1, line 3]
- "Mild temporal wasting" (2026-10-25 21:12) [Nutrition assessment DOC-000233, p. 1, line 3]

Question:
The dietitian assessment above is documented in this encounter. Based on your clinical judgement, can a related nutritional diagnosis, including severity, be documented?

Response options (select one or write your own):
( ) Moderate protein-calorie malnutrition
( ) Severe protein-calorie malnutrition
( ) 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 · Clinical judgement required Clinical judgement required: AKI criteria met only against a presumed baseline (no pre-admission creatinine on file).
Acute blood loss anaemia · Specificity gap Documented “anemia” (D64.9); criteria support the more specific Acute blood loss anemia (D62).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2104	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00068, ENC-00068.malnutrition	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt d06d622e0ef6 output de34f00338d8 entry f839f566ca5e
1278	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00068, ENC-00068.malnutrition	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt d06d622e0ef6 output de34f00338d8 entry e1681d1cf0b2
536	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00068, ENC-00068.malnutrition	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt d06d622e0ef6 output de34f00338d8 entry 6ffd64395f65