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: Obesity

ENC-00080 · 85F · Cardiology · admitted Sun Nov 08, 2026 08:57 PM · in hospital · attending Dr. Wes Merriweather · resident Dr. Elena Nakashima

Clinical validation gap Criteria met Open In hospital: concurrent review Resident note awaiting attending cosign

Documented “morbid obesity” (E66.01) conflicts with what the criteria support (Obesity, class 1, E66.811).

Documented vs supported

Documented: “morbid obesity” · E66.01 Morbid (severe) obesity due to excess calories
Criteria support: Obesity, class 1 · E66.811 Obesity, class 1
Outcome: BMI 32 (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: E66.01 -> E66.811
Secondary-diagnosis level: non-CC → 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, J96.01, D62, I10, K21.9, E11.9, E66.811

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.

Evidence (each item cited to a source row or a quoted span)
Input	Value	Source
BMI from charted height and weight (kg/m2)	32.0	height 162 cm, weight 84 kg -> BMI 32.0 · encounter ENC-00080
Age (years)	85	age 85 · encounter ENC-00080

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=85, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=32.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.0, t.c1=30	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2125); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: weight-related documentation
Encounter: ENC-00080   Patient: Priya Nakashima   To: Dr. Wes Merriweather

Clinical indicators from the health record:
- Documented in the record: "morbid obesity" [Progress note DOC-000276]
- height 162 cm, weight 84 kg -> BMI 32.0 [encounter ENC-00080]

Question:
The measurements above are documented in this encounter. Could you clarify the documented weight-related diagnosis?

Response options (select one or write your own):
( ) Morbid obesity: confirmed (please document the supporting clinical information)
( ) Obesity, class 1 (BMI 30-34.9)
( ) Obesity, class 2 (BMI 35-39.9)
( ) Other explanation of the clinical findings (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

Chronic kidney disease · Specificity gap Criteria support Chronic kidney disease stage 3a (N18.31); no corresponding diagnosis is documented.
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).
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

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2125	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00080, ENC-00080.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry 5dad873ccb32
1299	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00080, ENC-00080.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry 7a6ce9f1698d
557	2026-11-14T18:29:05	system:llm system	`llm.call`	ENC-00080, ENC-00080.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry 4bcf12a4aa18