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 | Priya Ivers · Heart failure ENC-00150 · Cardiology |
Specificity gap | “chronic systolic heart failure” I50.22 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 2 | Dmitri Galloway · Obesity ENC-00151 · General Surgery Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 378 → 378 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 3 | Ximena Delacroix · Heart failure ENC-00161 · Cardiology |
Specificity gap | “CHF” I50.9 |
Acute diastolic (HFpEF) heart failure I50.31 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 4 | Quinn Northam · Heart failure ENC-00164 · Pulmonology |
Specificity gap | “HFrEF” I50.20 |
Chronic systolic (HFrEF) heart failure I50.22 |
CC → CC MS-DRG 191 → 191 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 5 | Quinn Northam · Obesity ENC-00164 · Pulmonology Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 191 → 191 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 6 | Blake Coldridge · Heart failure ENC-00175 · Cardiology |
Specificity gap | “heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
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.