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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Priya Ivers: Acute kidney injury

ENC-00150 · 69M · Cardiology · admitted Mon Nov 02, 2026 06:18 PM · discharged Sat Nov 07, 2026 01:16 PM · attending Dr. Rosalind Quillan

Clinical judgement required Clinical judgement required Open

Clinical judgement required: AKI criteria met only against a presumed baseline (no pre-admission creatinine on file).

Documented vs supported

Documented: “acute renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
Criteria support: no conclusion: clinical judgement required
Outcome: AKI criteria met only against a presumed baseline (no pre-admission creatinine on file)
Rule: Acute kidney injury (KDIGO staging) v2026.11-1
Published source: KDIGO Clinical Practice Guideline for Acute Kidney Injury (Kidney Int Suppl 2012;2:19-36) (2012), Recommendations 2.1.1 (definition) and 2.1.2 (staging), Table 2 · source (checked 2026-11-14)

Clinical judgement required. The rule does not conclude here. A CDI specialist may send an open query or dismiss the finding; nothing is proposed as fact.

Effect if the clinician agrees (illustrative)

Change: no projected change (clinician judgement)
Secondary-diagnosis level: non-CC → —
MS-DRG (illustrative): 292 Heart failure and shock with CC → 292 Heart failure and shock with CC
Relative weight: 0.8490 → 0.8490 (+0.0000)
Codes before: I50.22, N28.9, E87.1, K21.9, E11.9, E78.5
Codes after: I50.22, N28.9, E87.1, K21.9, E11.9, E78.5

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

0.0 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
Baseline creatinine (mg/dL); most recent pre-admission value within 365 days, else lowest this stay (presumed) no pre-admission value: lowest value this stay used as a presumed baseline	1.08	creatinine 1.08 mg/dL (lowest this stay) · lab LAB-005140 · 2026-11-07 05:00
Peak creatinine this stay (mg/dL)	1.93	creatinine 1.93 mg/dL (peak this stay) · lab LAB-005135 · 2026-11-02 19:18
Peak / baseline peak / baseline	1.787	creatinine 1.93 mg/dL (peak this stay) · lab LAB-005135 · 2026-11-02 19:18 creatinine 1.08 mg/dL (lowest this stay) · lab LAB-005140 · 2026-11-07 05:00
Largest creatinine rise between two values within 48 h (mg/dL) largest rise between two values within 48 hours	0.0	derived (largest rise between two values within 48 hours)

Rule trace (inputs, thresholds, outcome)

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.787, creat_rise_48h=0.0, t.ratio_s1=1.5, t.rise_abs=0.3, t.uo_s1_h=6, uo_hours_lt_0_5=unknown	true
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	anuria_hours=unknown, creat_peak=1.93, creat_ratio=1.787, meets_definition=True, rrt_started=False, t.anuria_h=12, t.ratio_s3=3.0, t.scr_s3=4.0, t.uo_s3_h=24, uo_hours_lt_0_3=unknown	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=1.787, t.ratio_s2=2.0, t.uo_s2_h=12, uo_hours_lt_0_5=unknown	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	meets_definition=True, stage2=False, stage3=False	1
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=False, creat_rise_48h=0.0, rrt_started=False, t.rise_abs=0.3	false
outcome: aki_staged	`stage >= 1 and baseline_independent`	baseline_independent=False, stage=1	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=1	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2252); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: kidney function documentation
Encounter: ENC-00150   Patient: Priya Ivers   To: Dr. Rosalind Quillan

Clinical indicators from the health record:
- Documented in the record: "acute renal insufficiency" [Progress note DOC-000508]
- creatinine 1.08 mg/dL (lowest this stay) (2026-11-07 05:00) [lab LAB-005140]
- creatinine 1.93 mg/dL (peak this stay) (2026-11-02 19:18) [lab LAB-005135]

Question:
Could you review the kidney function indicators above and clarify any related diagnosis, if clinically appropriate?

Response options (select one or write your own):
( ) Acute kidney injury (please specify stage, if known)
( ) 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

Heart failure · Specificity gap Documented “chronic systolic heart failure” (I50.22); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).
Hyponatraemia · Clinical validation gap Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 137).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2252	2026-11-14T20:57:25	system:llm system	`llm.call`	ENC-00150, ENC-00150.aki	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt f0cdabb7d1a8 output 437190b718a1 entry d39ca1b633c0
1426	2026-11-14T19:24:31	system:llm system	`llm.call`	ENC-00150, ENC-00150.aki	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt f0cdabb7d1a8 output 437190b718a1 entry 0d4aa1b5e024
684	2026-11-14T18:29:06	system:llm system	`llm.call`	ENC-00150, ENC-00150.aki	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt f0cdabb7d1a8 output 437190b718a1 entry d0943ed787e8