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Uma Quillan: Obesity
ENC-00142 · 71F · Cardiology · admitted Mon Nov 09, 2026 02:43 PM · in hospital · attending Dr. Kenji Stavros · resident Dr. Priya Thorne
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 41.2 (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)
- 293 Heart failure and shock without CC/MCC → 292 Heart failure and shock with CC
- Relative weight
- 0.5660 → 0.8490 (+0.2830)
- Codes before
- I50.23
- Codes after
- I50.23, E66.813, Z68.41
All open gaps on this encounter together: MS-DRG 293 → 292 (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.
| Input | Value | Source |
|---|---|---|
| BMI from charted height and weight (kg/m2) | 41.2 |
height 153 cm, weight 96.4 kg -> BMI 41.2
|
| Age (years) | 71 |
age 71
|
Rule trace (inputs, thresholds, outcome)
| Step | Expression | Inputs and thresholds read | Result |
|---|---|---|---|
| outcome: not_adult | age < t.adult |
age=71, t.adult=20 | false |
| outcome: class3 | bmi >= t.c3 |
bmi=41.2, t.c3=40 | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2243); 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-00142 Patient: Uma Quillan To: Dr. Kenji Stavros Clinical indicators from the health record: - height 153 cm, weight 96.4 kg -> BMI 41.2 [encounter ENC-00142] 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.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2243 | 2026-11-14T20:57:25 | system:llm system |
llm.call |
ENC-00142, ENC-00142.obesity | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry bb8b87a22994 |
| 1417 | 2026-11-14T19:24:31 | system:llm system |
llm.call |
ENC-00142, ENC-00142.obesity | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 6066595d0895 |
| 675 | 2026-11-14T18:29:06 | system:llm system |
llm.call |
ENC-00142, ENC-00142.obesity | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 7458775ce14c |