← How it decides

Two-sided comparison of documented kidney statements with the computed criteria

Compare with what the note says, in both directions; say 'not assessable' when the data cannot decide.

Rule and version

kidney_compare@1.0 (superseded)

Published source

Directions are this tool's definitions. Documentation rule: ICD-10-CM Official Guidelines for Coding and Reporting FY2026, Section I.A.19 (code assignment rests on the provider's statement, not on clinical criteria), so the comparison flags, it never assigns. Panel wording: ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice (2026 update): no diagnosis named beside 'criteria met', nothing implied by layout, no payment, quality or denial words, every value cited. https://www.cms.gov/medicare/coding-billing/icd-10-codes

Edition

Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update

Effective

from 2026-11-01

Role

direction of each finding

Status

superseded

Clinical reviewer

—

Coding reviewer

—

Sponsor

none

Body hash

33e04e11cb63b758acdf33b06ccf5c4282a196cb908687d099469e7cfc95b9e0

Thresholds and parameters

{
  "aki_precedence": "met at peak under 4 of 4 baselines -> UNDER or CONSISTENT; under 0 of 4 -> UNSUPPORTED or NONE; otherwise DEFINITIONS_DISAGREE",
  "ckd_precedence": "if the 2009 and 2021 equations give a different CKD status or a different stage, the direction is DEFINITIONS_DISAGREE (both shown; the tool never chooses); otherwise the shared direction",
  "counted_as_over": [
    "UNSUPPORTED"
  ],
  "counted_as_under": [
    "UNDER"
  ],
  "directions": {
    "CONSISTENT": "statement and computed result agree",
    "DEFINITIONS_DISAGREE": "the definitions (2009 vs 2021 equation, or the four creatinine baselines) lead to different directions; both are shown and the tool never chooses",
    "NONE": "criteria not met and nothing documented",
    "NOT_ASSESSED": "the check does not apply to this encounter",
    "SPECIFICITY_GAP": "criteria met and the statement is unstaged or its stage differs from the computed G category",
    "UNDER": "criteria met (all definitions) and no matching statement for the encounter",
    "UNSUPPORTED": "a statement exists and the criteria are not met (all definitions)"
  },
  "statement_preference": "the current draft note's statement, else the encounter diagnosis list",
  "statement_stage": {
    "N18.1": "G1",
    "N18.2": "G2",
    "N18.30": "G3",
    "N18.31": "G3a",
    "N18.32": "G3b",
    "N18.4": "G4",
    "N18.5": "G5",
    "N18.6": "G5",
    "N18.9": null
  }
}

Boundary tests: 0/0 pass

None for this rule.