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-00074

Ximena Bellweather: Obesity

ENC-00074 · 87M · Hospital Medicine · admitted Tue Nov 10, 2026 02:08 PM · in hospital · attending Dr. Rosalind Quillan · resident Dr. Priya Thorne

Specificity gap Criteria met Open In hospital: concurrent review Resident note awaiting attending cosign Model draft failed the query linter: edit before sending

Documented “obesity” (E66.9); criteria support the more specific Obesity, class 3 (E66.813).

Documented vs supported

Documented: “obesity” · E66.9 Obesity, unspecified
Criteria support: Obesity, class 3 · E66.813 Obesity, class 3
Outcome: BMI 42.5 (class 3)
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 -> E66.813
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 871 Septicemia or severe sepsis without MV >96 hours with MCC → 871 Septicemia or severe sepsis without MV >96 hours with MCC
Relative weight: 1.9425 → 1.9425 (+0.0000)
Codes before: A41.9, J18.9, E66.9, I10, E11.9
Codes after: A41.9, J18.9, I10, E11.9, E66.813, Z68.41

All open gaps on this encounter together: MS-DRG 871 → 871 (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

0.5 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)	42.5	height 177 cm, weight 133.3 kg -> BMI 42.5 · encounter ENC-00074
Age (years)	87	age 87 · encounter ENC-00074

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=87, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=42.5, t.c3=40	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2116); 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-00074   Patient: Ximena Bellweather   To: Dr. Rosalind Quillan

Clinical indicators from the health record:
- Documented in the record: "obesity" [Progress note DOC-000257]
- height 177 cm, weight 133.3 kg -> BMI 42.5 [encounter ENC-00074]

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

Response options (select one or write your own):
( ) Obesity, class 3 (BMI 40 or higher)
( ) 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 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
2116	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00074, ENC-00074.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 7d0e18cddebe
1290	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00074, ENC-00074.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 1968da18caf9
548	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00074, ENC-00074.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 93488b4468bc