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.
Exact Dx: documentation worklist
Published clinical criteria, applied as versioned rules to 180 synthetic inpatient encounters. The tool looks both ways: it flags documentation that is less specific than the chart supports and documented diagnoses the criteria do not support. Rows are ranked by the absolute size of the change, so removing an unsupported code ranks the same as adding a supported one. Nothing changes in the record until a clinician answers a query.
206
Specificity gapChart supports a more specific diagnosis than documented.
93
Clinical validation gapDocumented diagnosis the criteria do not support.
57
Clinical judgement requiredBorderline or contested: the rule declines to conclude.
| # | Encounter · condition | Kind | Documented | Criteria support | Effect (illustrative, FY2026) | Priority | Status | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Florian Treadwell · Malnutrition ENC-00134 · Hospital Medicine |
Clinical judgement required | “malnutrition” E46 |
clinician judgement | CC → — MS-DRG 871 → 871 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 2 | Kenji Juniper · Acute kidney injury ENC-00135 · Hospital Medicine |
Clinical judgement required | “renal insufficiency” N28.9 |
clinician judgement | non-CC → — MS-DRG 689 → 689 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 3 | Hollis Kestrel · Acute respiratory failure ENC-00139 · Cardiology |
Clinical judgement required | “hypoxia” R09.02 |
clinician judgement | non-CC → — MS-DRG 293 → 293 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 4 | Farah Juniper · Acute kidney injury ENC-00141 · Hospital Medicine |
Clinical judgement required | “worsening renal function” N28.9 |
clinician judgement | non-CC → — MS-DRG 194 → 194 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 5 | Priya Ivers · Acute kidney injury ENC-00150 · Cardiology |
Clinical judgement required | “acute renal insufficiency” N28.9 |
clinician judgement | non-CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 6 | Ximena Pemberton · Chronic kidney disease ENC-00159 · Pulmonology |
Clinical judgement required | “CKD stage 3a” N18.31 |
clinician judgement | non-CC → — MS-DRG 190 → 190 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 7 | Nadia Greaves · Heart failure ENC-00162 · Hospital Medicine |
Clinical judgement required | “CHF” I50.9 |
clinician judgement | non-CC → — MS-DRG 690 → 690 (RW +0.0000) |
10
|
Open |
"Approved" in the status column means the query was sent; "Rejected" means a CDI specialist dismissed the finding with a reason. Grouping effects use a small embedded subset of public CMS FY2026 tables and are illustrative, never a payment estimate.