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-00080
Priya Nakashima: Chronic kidney disease
ENC-00080 · 85F · Cardiology · admitted Sun Nov 08, 2026 08:57 PM · in hospital · attending Dr. Wes Merriweather · resident Dr. Elena Nakashima
Specificity gap Criteria met Open
In hospital: concurrent review Resident note awaiting attending cosign
Criteria support Chronic kidney disease stage 3a (N18.31); no corresponding diagnosis is documented.
Documented vs supported
- Documented
- not documented
- Criteria support
- Chronic kidney disease stage 3a · N18.31 Chronic kidney disease, stage 3a
- Outcome
- Two eGFR values >=90 days apart, both below 60; staging value 56.6 (G3a)
- 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
- add N18.31
- Secondary-diagnosis level
- — → non-CC
- MS-DRG (illustrative)
- 291 Heart failure and shock with MCC → 291 Heart failure and shock with MCC
- Relative weight
- 1.2838 → 1.2838 (+0.0000)
- Codes before
- I50.22, E66.01, J96.01, D62, I10, K21.9, E11.9
- Codes after
- I50.22, E66.01, J96.01, D62, I10, K21.9, E11.9, N18.31
All open gaps on this encounter together: MS-DRG 291 → 292 (RW -0.4348).
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 0.98 -> eGFR 57
creatinine 1.06 -> eGFR 51
|
| Days between the earliest and latest pre-admission eGFR values | 372 |
creatinine 0.98 mg/dL -> eGFR 57 (CKD-EPI 2021)
creatinine 1.06 mg/dL -> eGFR 51 (CKD-EPI 2021)
|
| Earliest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021) | 56.6 |
creatinine 0.98 mg/dL -> eGFR 57 (CKD-EPI 2021)
|
| Latest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021) | 51.5 |
creatinine 1.06 mg/dL -> eGFR 51 (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=372, t.chronic_days=90 | true |
| derived: staging_egfr | max(egfr_early, egfr_late) |
egfr_early=56.6, egfr_late=51.5 | 56.6 |
| derived: both_below_60 | egfr_early < t.g2 and egfr_late < t.g2 |
egfr_early=56.6, egfr_late=51.5, 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=56.6, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15 | G3a |
| 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=56.6, egfr_late=51.5, t.g2=60 | false |
| outcome: g1_g2 | staging_egfr >= t.g2 |
staging_egfr=56.6, t.g2=60 | false |
| outcome: g3a | category == 'G3a' |
category=G3a | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2123); 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-00080 Patient: Priya Nakashima To: Dr. Wes Merriweather Clinical indicators from the health record: - creatinine 0.98 -> eGFR 57 (2025-09-30 09:15) [lab LAB-002709] - creatinine 1.06 -> eGFR 51 (2026-10-07 10:05) [lab LAB-002710] 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) ( ) 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 · Specificity gap Documented “chronic systolic heart failure” (I50.22); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).
- Obesity · Clinical validation gap Documented “morbid obesity” (E66.01) conflicts with what the criteria support (Obesity, class 1, E66.811).
- Acute respiratory failure · Clinical validation gap Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), oxygen no more than 2 L/min, no advanced support.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2123 | 2026-11-14T20:57:24 | system:llm system |
llm.call |
ENC-00080, ENC-00080.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 1226434960ee |
| 1297 | 2026-11-14T19:24:29 | system:llm system |
llm.call |
ENC-00080, ENC-00080.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry df791ccd9baa |
| 555 | 2026-11-14T18:29:05 | system:llm system |
llm.call |
ENC-00080, ENC-00080.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 89b0b221d4af |