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-00087

Lena Northam: Obesity

ENC-00087 · 78M · Hospital Medicine · admitted Mon Nov 09, 2026 01:46 PM · in hospital · attending Dr. Kenji Stavros · resident Dr. Elena Nakashima

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

Criteria support Obesity, class 3 (E66.813); no corresponding diagnosis is documented.

Documented vs supported

Documented: not documented
Criteria support: Obesity, class 3 · E66.813 Obesity, class 3
Outcome: BMI 40.7 (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: add E66.813
Secondary-diagnosis level: — → 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, N39.0, N18.9, I50.9, J96.01, D64.9
Codes after: A41.9, N39.0, N18.9, I50.9, J96.01, D64.9, 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)	40.7	height 162 cm, weight 106.8 kg -> BMI 40.7 · encounter ENC-00087
Age (years)	78	age 78 · encounter ENC-00087

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=78, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=40.7, t.c3=40	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2137); 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-00087   Patient: Lena Northam   To: Dr. Kenji Stavros

Clinical indicators from the health record:
- height 162 cm, weight 106.8 kg -> BMI 40.7 [encounter ENC-00087]

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

Chronic kidney disease · Specificity gap Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 3a (N18.31).
Heart failure · Specificity gap Documented “congestive heart failure” (I50.9); criteria support the more specific Acute on chronic diastolic (HFpEF) heart failure (I50.33).
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 1 L/min, no advanced support.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2137	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00087, ENC-00087.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 40fe2524c0d7
1311	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00087, ENC-00087.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry aa147d7c8ccc
569	2026-11-14T18:29:05	system:llm system	`llm.call`	ENC-00087, ENC-00087.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 714f22946901