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-00133

Hana Quillan: Chronic kidney disease

ENC-00133 · 50F · Hospital Medicine · admitted Wed Oct 28, 2026 05:39 PM · discharged Thu Nov 05, 2026 04:42 PM · attending Dr. Rosalind Quillan · resident Dr. Priya Thorne

Specificity gap Criteria met Open

Criteria support Chronic kidney disease stage 3b (N18.32); no corresponding diagnosis is documented.

Documented vs supported

Documented: not documented
Criteria support: Chronic kidney disease stage 3b · N18.32 Chronic kidney disease, stage 3b
Outcome: Two eGFR values >=90 days apart, both below 60; staging value 41.2 (G3b)
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 N18.32
Secondary-diagnosis level: — → non-CC
MS-DRG (illustrative): 689 Kidney and urinary tract infections with MCC → 689 Kidney and urinary tract infections with MCC
Relative weight: 1.1603 → 1.1603 (+0.0000)
Codes before: N39.0, J96.01, D62, L89.150, K21.9, E11.9, I10
Codes after: N39.0, J96.01, D62, L89.150, K21.9, E11.9, I10, N18.32

All open gaps on this encounter together: MS-DRG 689 → 690 (RW -0.3508).

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
Number of pre-admission eGFR values within 2 years (inpatient values during acute illness are not used)	2	creatinine 1.53 -> eGFR 41 · lab LAB-004526 · 2025-09-28 09:15 creatinine 1.65 -> eGFR 38 · lab LAB-004527 · 2026-09-23 10:05
Days between the earliest and latest pre-admission eGFR values	360	creatinine 1.53 mg/dL -> eGFR 41 (CKD-EPI 2021) · lab LAB-004526 · 2025-09-28 09:15 creatinine 1.65 mg/dL -> eGFR 38 (CKD-EPI 2021) · lab LAB-004527 · 2026-09-23 10:05
Earliest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021)	41.2	creatinine 1.53 mg/dL -> eGFR 41 (CKD-EPI 2021) · lab LAB-004526 · 2025-09-28 09:15
Latest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021)	37.6	creatinine 1.65 mg/dL -> eGFR 38 (CKD-EPI 2021) · lab LAB-004527 · 2026-09-23 10:05

Rule trace (inputs, thresholds, outcome)

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
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=360, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=41.2, egfr_late=37.6	41.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=41.2, egfr_late=37.6, 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=41.2, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3b
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=41.2, egfr_late=37.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=41.2, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2224); 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: chronic kidney documentation
Encounter: ENC-00133   Patient: Hana Quillan   To: Dr. Rosalind Quillan

Clinical indicators from the health record:
- creatinine 1.53 -> eGFR 41 (2025-09-28 09:15) [lab LAB-004526]
- creatinine 1.65 -> eGFR 38 (2026-09-23 10:05) [lab LAB-004527]

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)
( ) Chronic kidney disease stage 4 (eGFR 15-29)
( ) 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 respiratory failure · Clinical validation gap Documented “acute hypoxic respiratory failure” (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
2224	2026-11-14T20:57:25	system:llm system	`llm.call`	ENC-00133, ENC-00133.ckd	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 431da5699d58
1398	2026-11-14T19:24:31	system:llm system	`llm.call`	ENC-00133, ENC-00133.ckd	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 5cf24b0774fc
656	2026-11-14T18:29:06	system:llm system	`llm.call`	ENC-00133, ENC-00133.ckd	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry bf8977107520