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.

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Amara Holloway: Obesity

ENC-00136 · 79F · Hospital Medicine · admitted Thu Nov 05, 2026 10:43 AM · discharged Sun Nov 08, 2026 10:07 AM · attending Dr. Gideon Zeller · resident Dr. Elena Nakashima

Clinical validation gap Criteria met Open

Documented “class 3 obesity” (E66.813) conflicts with what the criteria support (Obesity, class 1, E66.811).

Documented vs supported

Documented: “class 3 obesity” · E66.813 Obesity, class 3
Criteria support: Obesity, class 1 · E66.811 Obesity, class 1
Outcome: BMI 31.9 (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: E66.813 -> E66.811
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 194 Simple pneumonia and pleurisy with CC → 194 Simple pneumonia and pleurisy with CC
Relative weight: 0.8059 → 0.8059 (+0.0000)
Codes before: J18.9, E66.813, N18.9, N17.9, E78.5, E11.9, I10
Codes after: J18.9, N18.9, N17.9, E78.5, E11.9, I10, E66.811

All open gaps on this encounter together: MS-DRG 194 → 194 (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

0.0 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)	31.9	height 166 cm, weight 88 kg -> BMI 31.9 · encounter ENC-00136
Age (years)	79	age 79 · encounter ENC-00136

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=79, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=31.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=31.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=31.9, t.c1=30	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2233); 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-00136   Patient: Amara Holloway   To: Dr. Gideon Zeller

Clinical indicators from the health record:
- Documented in the record: "class 3 obesity" [Progress note DOC-000462]
- height 166 cm, weight 88 kg -> BMI 31.9 [encounter ENC-00136]

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):
( ) Class 3 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 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
2233	2026-11-14T20:57:25	system:llm system	`llm.call`	ENC-00136, ENC-00136.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry c67e3dc9f219
1407	2026-11-14T19:24:31	system:llm system	`llm.call`	ENC-00136, ENC-00136.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry f94b7c700a64
665	2026-11-14T18:29:06	system:llm system	`llm.call`	ENC-00136, ENC-00136.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 299b63ae96cf output 294535ad3d05 entry bff3003dd870