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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Vera Rourke: Acute kidney injury

ENC-00157 · 87M · Hospital Medicine · admitted Wed Nov 04, 2026 08:39 AM · discharged Wed Nov 11, 2026 12:43 PM · attending Dr. Jalen Carrow

Specificity gap Criteria met Open

Documented “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 3) (N17.9).

Documented vs supported

Documented: “renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
Criteria support: Acute kidney injury (KDIGO stage 3) · N17.9 Acute kidney failure, unspecified
Outcome: AKI criteria met, KDIGO stage 3
Note: ICD-10-CM does not code the KDIGO stage; the stage is shown so the clinician can document it.
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)

Effect if the clinician agrees (illustrative)

Change: N28.9 -> N17.9
Secondary-diagnosis level: non-CC → 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, N28.9, I50.20, E78.5
Codes after: J18.9, I50.20, E78.5, N17.9

All open gaps on this encounter together: MS-DRG 194 → 193 (RW +0.5085).

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
Baseline creatinine (mg/dL); most recent pre-admission value within 365 days, else lowest this stay (presumed) most recent pre-admission value within 365 days	0.95	creatinine 0.95 mg/dL (pre-admission) · lab LAB-005344 · 2026-08-15 10:05
Whether a pre-admission baseline exists	True	pre-admission creatinine on file · lab LAB-005344 · 2026-08-15 10:05
Peak creatinine this stay (mg/dL)	3.33	creatinine 3.33 mg/dL (peak this stay) · lab LAB-005346 · 2026-11-05 05:00
Peak / baseline peak / baseline	3.505	creatinine 3.33 mg/dL (peak this stay) · lab LAB-005346 · 2026-11-05 05:00 creatinine 0.95 mg/dL (pre-admission) · lab LAB-005344 · 2026-08-15 10:05
Largest creatinine rise between two values within 48 h (mg/dL) largest rise between two values within 48 hours	0.74	creatinine 2.59 · lab LAB-005345 · 2026-11-04 09:39 creatinine 3.33 · lab LAB-005346 · 2026-11-05 05:00
Longest run of urine output <0.5 mL/kg/h (hours; 6-hour blocks)	30	urine 110 mL / 6 h · vital VIT-015330 · 2026-11-04 20:39 urine 110 mL / 6 h · vital VIT-015331 · 2026-11-05 02:39 urine 110 mL / 6 h · vital VIT-015332 · 2026-11-05 08:39 urine 110 mL / 6 h · vital VIT-015333 · 2026-11-05 14:39 urine 110 mL / 6 h · vital VIT-015334 · 2026-11-05 20:39
Longest run of urine output <0.3 mL/kg/h (hours)	30	urine 110 mL / 6 h · vital VIT-015330 · 2026-11-04 20:39 urine 110 mL / 6 h · vital VIT-015331 · 2026-11-05 02:39 urine 110 mL / 6 h · vital VIT-015332 · 2026-11-05 08:39 urine 110 mL / 6 h · vital VIT-015333 · 2026-11-05 14:39 urine 110 mL / 6 h · vital VIT-015334 · 2026-11-05 20:39
Longest run with no urine output (hours)	0	derived (no source row)

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=3.505, creat_rise_48h=0.74, t.ratio_s1=1.5, t.rise_abs=0.3, t.uo_s1_h=6, uo_hours_lt_0_5=30	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=0, creat_peak=3.33, creat_ratio=3.505, 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=30	true
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=3.505, t.ratio_s2=2.0, t.uo_s2_h=12, uo_hours_lt_0_5=30	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	meets_definition=True, stage2=True, stage3=True	3
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.74, rrt_started=False, t.rise_abs=0.3	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	baseline_independent=True, stage=3	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2262); 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-00157   Patient: Vera Rourke   To: Dr. Jalen Carrow

Clinical indicators from the health record:
- Documented in the record: "renal insufficiency" [Progress note DOC-000529]
- creatinine 0.95 mg/dL (pre-admission) (2026-08-15 10:05) [lab LAB-005344]
- creatinine 3.33 mg/dL (peak this stay) (2026-11-05 05:00) [lab LAB-005346]
- creatinine 2.59 (2026-11-04 09:39) [lab LAB-005345]
- urine 110 mL / 6 h (2026-11-04 20:39) [vital VIT-015330]
- urine 110 mL / 6 h (2026-11-05 02:39) [vital VIT-015331]
- urine 110 mL / 6 h (2026-11-05 08:39) [vital VIT-015332]
- urine 110 mL / 6 h (2026-11-05 14:39) [vital VIT-015333]
- urine 110 mL / 6 h (2026-11-05 20:39) [vital VIT-015334]

Question:
Based on your clinical judgement and the indicators above, can the kidney diagnosis being monitored and treated be further specified?

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

Acute blood loss anaemia · Specificity gap Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.
Heart failure · Specificity gap Documented “systolic heart failure” (I50.20); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).
Obesity · Specificity gap Criteria support Obesity, class 1 (E66.811); no corresponding diagnosis is documented.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2262	2026-11-14T20:57:26	system:llm system	`llm.call`	ENC-00157, ENC-00157.aki	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt aa134379ab6c output 968dc8741b13 entry 58393eab4748
1436	2026-11-14T19:24:31	system:llm system	`llm.call`	ENC-00157, ENC-00157.aki	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt aa134379ab6c output 968dc8741b13 entry 85502682525b
694	2026-11-14T18:29:06	system:llm system	`llm.call`	ENC-00157, ENC-00157.aki	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt aa134379ab6c output 968dc8741b13 entry 16583a27fed3