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-00094

Zara Juniper: Hyponatraemia

ENC-00094 · 53M · Cardiology · admitted Sun Nov 01, 2026 06:53 PM · discharged Sun Nov 08, 2026 10:29 AM · attending Dr. Cyrus Ellingham · resident Dr. Priya Thorne

Clinical validation gap Criteria not met Open

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).

Documented vs supported

Documented: “hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
Criteria support: criteria not met
Outcome: All sodium values 135 or above (lowest 136)
Rule: Hyponatraemia v2026.11-1
Published source: Clinical practice guideline on diagnosis and treatment of hyponatraemia (Spasovski et al., Eur J Endocrinol 2014;170:G1-G47) (2014), Classification by biochemical severity: mild 130-135, moderate 125-129, profound <125 mmol/L · source (checked 2026-11-14)

Effect if the clinician agrees (illustrative)

Change: remove E87.1
Secondary-diagnosis level: CC → removed
MS-DRG (illustrative): 292 Heart failure and shock with CC → 293 Heart failure and shock without CC/MCC
Relative weight: 0.8490 → 0.5660 (-0.2830)
Codes before: I50.33, N18.9, E87.1
Codes after: I50.33, N18.9

All open gaps on this encounter together: MS-DRG 292 → 293 (RW -0.2830).

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
Lowest serum sodium this stay (mmol/L)	136.0	sodium 136 mmol/L · lab LAB-003197 · 2026-11-04 05:00
Number of sodium values below 135	0	derived (no source row)

Rule trace (inputs, thresholds, outcome)

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=136.0, t.low=135, t.moderate=130, t.profound=125	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_low_count=0, na_min=136.0, na_treated=False, t.low=135, t.repeat=2	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2152); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: electrolyte documentation
Encounter: ENC-00094   Patient: Zara Juniper   To: Dr. Cyrus Ellingham

Clinical indicators from the health record:
- Documented in the record: "hyponatremia" [Progress note DOC-000320]
- sodium 136 mmol/L (2026-11-04 05:00) [lab LAB-003197]

Question:
The indicators above are documented in this encounter. Could you clarify the status of the documented electrolyte diagnosis?

Response options (select one or write your own):
( ) Hyponatremia: confirmed (please document the supporting clinical information)
( ) Hyponatremia: ruled out
( ) 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 Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 3b (N18.32).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2152	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00094, ENC-00094.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 93e8559a2fcf output b161c13a4bee entry c55854647672
1326	2026-11-14T19:24:30	system:llm system	`llm.call`	ENC-00094, ENC-00094.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 93e8559a2fcf output b161c13a4bee entry d4c8cb5c5f79
584	2026-11-14T18:29:05	system:llm system	`llm.call`	ENC-00094, ENC-00094.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 93e8559a2fcf output b161c13a4bee entry b5acc8afca83