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-00083
Jalen Penhallow: Acute respiratory failure
ENC-00083 · 49F · General Surgery · admitted Sat Nov 07, 2026 10:07 PM · discharged Tue Nov 10, 2026 01:22 PM · attending Dr. Wes Merriweather
Specificity gap Criteria met Open
Criteria support Acute respiratory failure with hypoxia (J96.01); no corresponding diagnosis is documented.
Documented vs supported
- Documented
- not documented
- Criteria support
- Acute respiratory failure with hypoxia · J96.01 Acute respiratory failure with hypoxia
- Outcome
- Hypoxaemia criterion met with a sign of respiratory distress
- Rule
- Acute hypoxic respiratory failure v2026.11-1
- Published source
- Merck Manual Professional Version: Acute Hypoxemic Respiratory Failure (AHRF), including ARDS (2026), Definition/evaluation: PaO2 <60 mmHg, PaO2/FiO2 <300, or SpO2 <88%, with dyspnea and tachypnea · source (checked 2026-11-14)
- Contested
- Organizations use different oxygen-saturation cut-offs (SpO2 <88%, <=90% or <91% on room air). This rule uses <88% (the source above) and a LOCAL respiratory-rate cut-off of 28/min as one sign of respiratory distress.
Effect if the clinician agrees (illustrative)
- Change
- add J96.01
- Secondary-diagnosis level
- — → MCC
- MS-DRG (illustrative)
- 378 GI hemorrhage with CC → 377 GI hemorrhage with MCC
- Relative weight
- 0.9807 → 1.8280 (+0.8473)
- Codes before
- K92.2, E44.0, E87.1, K21.9
- Codes after
- K92.2, E44.0, E87.1, K21.9, J96.01
All open gaps on this encounter together: MS-DRG 378 → 377 (RW +0.8473).
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
1.0 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 |
|---|---|---|
| Lowest SpO2 on room air (%) | 86.0 |
SpO2 86% on room air
|
| Lowest PaO2 on room air (mmHg) | 57.0 |
PaO2 57 mmHg on room air
|
| Lowest PaO2/FiO2 ratio PaO2 / FiO2 (room air FiO2 0.21 when none recorded) |
271 |
PaO2 57 mmHg
FiO2 21
|
| Highest respiratory rate (/min) | 28.0 |
respiratory rate 28/min
|
| Highest supplemental oxygen flow (L/min) | 5.0 |
O2 5 L/min (nasal cannula)
|
Rule trace (inputs, thresholds, outcome)
| Step | Expression | Inputs and thresholds read | Result |
|---|---|---|---|
| derived: measured | present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min) |
pao2_min_ra=57.0, pf_min=271, spo2_min_ra=86.0 | true |
| derived: hypoxemia | coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false) |
pao2_min_ra=57.0, pf_min=271, spo2_min_ra=86.0, t.pao2=60, t.pf=300, t.spo2_ra=88 | true |
| derived: distress | coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support |
adv_resp_support=False, rr_max=28.0, t.rr_distress=28, wob_increased=unknown | true |
| outcome: chronic_baseline | home_o2 and hypoxemia |
home_o2=False, hypoxemia=True | false |
| outcome: met | hypoxemia and distress |
distress=True, hypoxemia=True | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2132); clinical indicators and answer options assembled by code from the rule and the record.
Sign in to act. Sign in as a demo user (a CDI specialist sends queries).
DOCUMENTATION QUERY (draft) Title: Clarification request: respiratory documentation Encounter: ENC-00083 Patient: Jalen Penhallow To: Dr. Wes Merriweather Clinical indicators from the health record: - SpO2 86% on room air (2026-11-07 22:27) [vital VIT-008153] - PaO2 57 mmHg on room air (2026-11-07 22:32) [lab LAB-002821] - FiO2 21 (2026-11-07 22:32) [lab LAB-002822] - respiratory rate 28/min (2026-11-07 22:27) [vital VIT-008154] - O2 5 L/min (nasal cannula) (2026-11-07 22:37) [vital VIT-008155] Question: Based on your clinical judgement and the indicators above, can the respiratory diagnosis being evaluated and treated be further specified? Response options (select one or write your own): ( ) Acute respiratory failure with hypoxia ( ) Hypoxemia without respiratory failure ( ) 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 blood loss anaemia · Specificity gap Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2132 | 2026-11-14T20:57:24 | system:llm system |
llm.call |
ENC-00083, ENC-00083.respiratory_failure | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt f94cfa3b4fef output 5de8fced5850 entry 59785a87eb4c |
| 1306 | 2026-11-14T19:24:29 | system:llm system |
llm.call |
ENC-00083, ENC-00083.respiratory_failure | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt f94cfa3b4fef output 5de8fced5850 entry a39e5cb149f4 |
| 564 | 2026-11-14T18:29:05 | system:llm system |
llm.call |
ENC-00083, ENC-00083.respiratory_failure | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt f94cfa3b4fef output 5de8fced5850 entry c8d75bd20be6 |