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-00178
Quinn Kestrel: Pressure injury
ENC-00178 · 50F · Hospital Medicine · admitted Tue Nov 10, 2026 11:09 AM · in hospital · attending Dr. Jalen Carrow
Specificity gap Criteria met Open
In hospital: concurrent review
Documented “sacral pressure ulcer” (L89.159); criteria support the more specific Pressure injury of sacral region, stage 3 (L89.153).
Documented vs supported
- Documented
- “sacral pressure ulcer” · L89.159 Pressure ulcer of sacral region, unspecified stage
- Criteria support
- Pressure injury of sacral region, stage 3 · L89.153 Pressure ulcer of sacral region, stage 3
- Outcome
- Wound nurse documents stage 3, sacral
- Rule
- Pressure injury stage (sacral region) v2026.11-1
- Published source
- NPIAP Pressure Injury Stages (revised staging system) (2016), Stage 1-4, unstageable, deep tissue pressure injury definitions · source (checked 2026-11-14)
Effect if the clinician agrees (illustrative)
- Change
- L89.159 -> L89.153
- Secondary-diagnosis level
- non-CC → MCC
- MS-DRG (illustrative)
- 193 Simple pneumonia and pleurisy with MCC → 193 Simple pneumonia and pleurisy with MCC
- Relative weight
- 1.3144 → 1.3144 (+0.0000)
- Codes before
- J18.9, E46, N28.9, I50.33, D62, L89.159
- Codes after
- J18.9, E46, N28.9, I50.33, D62, L89.153
All open gaps on this encounter together: MS-DRG 193 → 193 (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
1.0 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.
| Input | Value | Source |
|---|---|---|
| Stage quoted from the wound-care note | 3 |
“Stage: 3”
Show the quote in the noteWOUND CARE NOTE
Patient: Quinn Kestrel MRN: MRN99953773
Location: sacrum
Stage: 3 (NPIAP)
Description: full-thickness skin loss, adipose visible, no tendon or bone.
Size: 3.8 x 1.8 x 0.9 cm.
Plan: offloading every 2 hours, foam dressing, nut … |
| Site quoted from the wound-care note | sacral |
“Location: sacrum”
Show the quote in the noteWOUND CARE NOTE
Patient: Quinn Kestrel MRN: MRN99953773
Location: sacrum
Stage: 3 (NPIAP)
Description: full-thickness skin loss, adipose visible, no tendon or bone.
Size: 3.8 x 1.8 x 0.9 cm.
Plan: offloading every 2 hours, foam dres … |
Rule trace (inputs, thresholds, outcome)
| Step | Expression | Inputs and thresholds read | Result |
|---|---|---|---|
| derived: sacral | wound_site == 'sacral' |
wound_site=sacral | true |
| outcome: no_wound_note | not present(wound_stage) |
wound_stage=3 | false |
| outcome: other_site | wound_site != 'sacral' |
wound_site=sacral | false |
| outcome: stage1 | sacral and wound_stage == '1' |
sacral=True, wound_stage=3 | false |
| outcome: stage2 | sacral and wound_stage == '2' |
sacral=True, wound_stage=3 | false |
| outcome: stage3 | sacral and wound_stage == '3' |
sacral=True, wound_stage=3 | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2309); clinical indicators and answer options assembled by code from the rule and the record.
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DOCUMENTATION QUERY (draft) Title: Clarification request: skin integrity documentation Encounter: ENC-00178 Patient: Quinn Kestrel To: Dr. Jalen Carrow Clinical indicators from the health record: - Documented in the record: "sacral pressure ulcer" [Progress note DOC-000598] - "Stage: 3" (2026-11-11 15:09) [Wound care note DOC-000596, p. 1, line 5] - "Location: sacrum" (2026-11-11 15:09) [Wound care note DOC-000596, p. 1, line 4] Question: The wound-care documentation above is part of this encounter. Based on your clinical judgement, can a related diagnosis be documented, including site and stage? Response options (select one or write your own): ( ) Pressure ulcer of sacral region, stage 3 ( ) 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 kidney injury · Specificity gap Documented “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 3) (N17.9).
- Acute blood loss anaemia · Clinical judgement required Clinical judgement required: Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL).
- Heart failure · Clinical validation gap Documented “acute on chronic diastolic heart failure” (I50.33) is more specific than the criteria support (Chronic diastolic (HFpEF) heart failure, I50.32).
- Malnutrition · Clinical judgement required Clinical judgement required: Only one consensus characteristic documented; two are required.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2309 | 2026-11-14T20:57:26 | system:llm system |
llm.call |
ENC-00178, ENC-00178.pressure_injury | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 94204f2cd745 output 29146ed5aa61 entry e27f679ee784 |
| 1483 | 2026-11-14T19:24:32 | system:llm system |
llm.call |
ENC-00178, ENC-00178.pressure_injury | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 94204f2cd745 output 29146ed5aa61 entry 3d12e14ef8f1 |
| 741 | 2026-11-14T18:29:07 | system:llm system |
llm.call |
ENC-00178, ENC-00178.pressure_injury | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 94204f2cd745 output 29146ed5aa61 entry 99575cd66482 |