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Exact Dx synthetic data · demonstration
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 gap

Chart supports a more specific diagnosis than documented.
93
Clinical validation gap

Documented diagnosis the criteria do not support.
57
Clinical judgement required

Borderline or contested: the rule declines to conclude.
Findings (1–50 of 93, highest priority first)
#Encounter · conditionKind DocumentedCriteria supportEffect (illustrative, FY2026) PriorityStatus
1 Lena Northam · Acute respiratory failure
ENC-00087 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute respiratory failure with hypoxia”
J96.01		 criteria not met MCC → removed
MS-DRG 871 → 872 (RW -0.9192)
100
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)25.0illustrative relative-weight change -0.9192 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
2 Lena Okafor · Pressure injury
ENC-00169 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “stage 4 sacral pressure ulcer”
L89.154		 Pressure injury of sacral region, stage 2
L89.152 		MCC → non-CC
MS-DRG 377 → 379 (RW -1.1976)
100
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> non-CC
Grouping change (illustrative)25.0illustrative relative-weight change -1.1976 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
3 Teodora Vance · Acute respiratory failure
ENC-00001 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute hypoxic respiratory failure”
J96.01		 criteria not met MCC → removed
MS-DRG 193 → 195 (RW -0.6859)
100
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)24.5illustrative relative-weight change -0.6859 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
4 Jun Galloway · Pressure injury
ENC-00067 · Hospital Medicine
In hospital: concurrent review		 Clinical validation gap “stage 4 sacral pressure ulcer”
L89.154		 Pressure injury of sacral region, stage 2
L89.152 		MCC → non-CC
MS-DRG 193 → 195 (RW -0.6859)
100
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> non-CC
Grouping change (illustrative)24.5illustrative relative-weight change -0.6859 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
5 Dario Ingram · Acute respiratory failure
ENC-00019 · Hospital Medicine 		Clinical validation gap “acute hypoxic respiratory failure”
J96.01		 criteria not met MCC → removed
MS-DRG 377 → 378 (RW -0.8473)
94
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)25.0illustrative relative-weight change -0.8473 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 3 day(s) ago
Open
6 Lena Lindqvist · Acute respiratory failure
ENC-00174 · Hospital Medicine 		Clinical validation gap “acute hypoxic respiratory failure”
J96.01		 criteria not met MCC → removed
MS-DRG 377 → 378 (RW -0.8473)
94
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)25.0illustrative relative-weight change -0.8473 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 3 day(s) ago
Open
7 Gideon Merriweather · Acute respiratory failure
ENC-00005 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute respiratory failure with hypoxia”
J96.01		 criteria not met MCC → removed
MS-DRG 193 → 194 (RW -0.5085)
93
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
8 Silas Dunmore · Acute respiratory failure
ENC-00137 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute respiratory failure with hypoxia”
J96.01		 criteria not met MCC → removed
MS-DRG 193 → 194 (RW -0.5085)
93
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
9 Priya Nakashima · Acute respiratory failure
ENC-00080 · Cardiology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute respiratory failure with hypoxia”
J96.01		 criteria not met MCC → removed
MS-DRG 291 → 292 (RW -0.4348)
91
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
10 Wes Oyelaran · Pressure injury
ENC-00117 · Cardiology 		Clinical validation gap “stage 4 sacral pressure ulcer”
L89.154		 Pressure injury of sacral region, stage 2
L89.152 		MCC → non-CC
MS-DRG 291 → 293 (RW -0.7178)
90
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> non-CC
Grouping change (illustrative)25.0illustrative relative-weight change -0.7178 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 11 days ago
Open
11 Odette Elsworth · Acute respiratory failure
ENC-00108 · Cardiology 		Clinical validation gap “acute hypoxic respiratory failure”
J96.01		 criteria not met MCC → removed
MS-DRG 291 → 292 (RW -0.4348)
85
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 3 day(s) ago
Open
12 Nico Ravensworth · Pressure injury
ENC-00043 · Cardiology 		Clinical validation gap “stage 4 sacral pressure ulcer”
L89.154		 Pressure injury of sacral region, stage 2
L89.152 		MCC → non-CC
MS-DRG 291 → 292 (RW -0.4348)
80
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> non-CC
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 8 days ago
Open
13 Farah Nakashima · Pressure injury
ENC-00090 · Cardiology 		Clinical validation gap “stage 4 sacral pressure ulcer”
L89.154		 Pressure injury of sacral region, stage 2
L89.152 		MCC → non-CC
MS-DRG 291 → 292 (RW -0.4348)
80
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> non-CC
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 4 days ago
Open
14 Hana Quillan · Acute respiratory failure
ENC-00133 · Hospital Medicine 		Clinical validation gap “acute hypoxic respiratory failure”
J96.01		 criteria not met MCC → removed
MS-DRG 689 → 690 (RW -0.3508)
77
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)12.5illustrative relative-weight change -0.3508 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 8 days ago
Open
15 Celeste Hartwell · Acute respiratory failure
ENC-00098 · Hospital Medicine
In hospital: concurrent review		 Clinical validation gap “acute respiratory failure with hypoxia”
J96.01		 criteria not met MCC → removed
MS-DRG 689 → 689 (RW +0.0000)
75
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
16 Mara Dunmore · Acute respiratory failure
ENC-00116 · Pulmonology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute respiratory failure with hypoxia”
J96.01		 criteria not met MCC → removed
MS-DRG 190 → 190 (RW +0.0000)
75
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
17 Dmitri Dunmore · Pressure injury
ENC-00149 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “stage 4 sacral pressure ulcer”
L89.154		 Pressure injury of sacral region, stage 2
L89.152 		MCC → non-CC
MS-DRG 689 → 689 (RW +0.0000)
75
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> non-CC
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
18 Lena Upfield · Malnutrition
ENC-00065 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “severe malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (chronic illness context)
E44.0 		MCC → CC
MS-DRG 193 → 194 (RW -0.5085)
73
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
19 Quinn Kestrel · Heart failure
ENC-00178 · Hospital Medicine
In hospital: concurrent review		 Clinical validation gap “acute on chronic diastolic heart failure”
I50.33		 Chronic diastolic (HFpEF) heart failure
I50.32 		MCC → CC
MS-DRG 193 → 194 (RW -0.5085)
73
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
20 Nico Merriweather · Malnutrition
ENC-00177 · Cardiology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “severe malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 291 → 292 (RW -0.4348)
71
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
21 Dmitri Greaves · Heart failure
ENC-00106 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute on chronic systolic heart failure”
I50.23		 Chronic systolic (HFrEF) heart failure
I50.22 		MCC → CC
MS-DRG 689 → 690 (RW -0.3508)
68
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)12.5illustrative relative-weight change -0.3508 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
22 Esme Northam · Acute kidney injury
ENC-00128 · Hospital Medicine
In hospital: concurrent review		 Clinical validation gap “acute kidney injury”
N17.9		 criteria not met CC → removed
MS-DRG 378 → 379 (RW -0.3503)
68
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)12.5illustrative relative-weight change -0.3503 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
23 Yusuf Pemberton · Malnutrition
ENC-00126 · Hospital Medicine 		Clinical validation gap “severe malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 193 → 194 (RW -0.5085)
67
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 3 day(s) ago
Open
24 Camila Upfield · Acute respiratory failure
ENC-00085 · Hospital Medicine 		Clinical validation gap “acute hypoxic respiratory failure”
J96.01		 criteria not met MCC → removed
MS-DRG 871 → 871 (RW +0.0000)
64
Priority score components
ComponentPointsWhy
Diagnosis-level change40.0secondary-diagnosis level MCC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 10 days ago
Open
25 Jalen Sallow · Malnutrition
ENC-00026 · Hospital Medicine 		Clinical validation gap “severe protein-calorie malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 193 → 194 (RW -0.5085)
63
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 10 days ago
Open
26 Ines Nakashima · Malnutrition
ENC-00041 · Hospital Medicine 		Clinical validation gap “severe malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 193 → 194 (RW -0.5085)
63
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 8 days ago
Open
27 Nico Bellweather · Malnutrition
ENC-00130 · Hospital Medicine 		Clinical validation gap “severe protein-calorie malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 193 → 194 (RW -0.5085)
63
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)18.2illustrative relative-weight change -0.5085 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 10 days ago
Open
28 Zara Whitlock · Malnutrition
ENC-00017 · Pulmonology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “malnourished”
E46		 criteria not met CC → removed
MS-DRG 191 → 192 (RW -0.2010)
62
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)7.2illustrative relative-weight change -0.2010 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
29 Gideon Ashgrove · Acute blood loss anaemia
ENC-00031 · Hospital Medicine 		Clinical validation gap “acute blood loss anemia”
D62		 Anemia (acute blood-loss criteria not met)
D64.9 		CC → non-CC
MS-DRG 378 → 379 (RW -0.3503)
62
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> non-CC
Grouping change (illustrative)12.5illustrative relative-weight change -0.3503 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 2 day(s) ago
Open
30 Ines Ashgrove · Malnutrition
ENC-00097 · Cardiology 		Clinical validation gap “severe protein-calorie malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 291 → 292 (RW -0.4348)
60
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 8 days ago
Open
31 Zara Abernath · Malnutrition
ENC-00146 · Cardiology 		Clinical validation gap “severe protein-calorie malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 291 → 292 (RW -0.4348)
60
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)15.5illustrative relative-weight change -0.4348 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 7 days ago
Open
32 Elena Okafor · Sepsis
ENC-00054 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign
Contested definitions (Sepsis-2 vs Sepsis-3)		 Clinical validation gap “sepsis”
A41.9		 criteria not met principal → removed
MS-DRG 871 → 194 (RW -1.1366)
60
Priority score components
ComponentPointsWhy
Diagnosis-level change0.0secondary-diagnosis level principal -> removed
Grouping change (illustrative)25.0illustrative relative-weight change -1.1366 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
33 Kenji Galloway · Hyponatraemia
ENC-00058 · Cardiology 		Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 292 → 293 (RW -0.2830)
59
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 3 day(s) ago
Open
34 Ines Ivers · Acute blood loss anaemia
ENC-00158 · Cardiology 		Clinical validation gap “acute blood loss anemia”
D62		 Anemia (acute blood-loss criteria not met)
D64.9 		CC → non-CC
MS-DRG 292 → 293 (RW -0.2830)
59
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> non-CC
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 3 day(s) ago
Open
35 Nico Greaves · Hyponatraemia
ENC-00044 · Hospital Medicine 		Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 194 → 195 (RW -0.1774)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)6.3illustrative relative-weight change -0.1774 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 1 day(s) ago
Open
36 Gideon Merriweather · Hyponatraemia
ENC-00005 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 193 → 193 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
37 Sana Ingram · Chronic kidney disease
ENC-00027 · Pulmonology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “CKD stage 4”
N18.4		 Chronic kidney disease stage 3b
N18.32 		CC → non-CC
MS-DRG 191 → 191 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> non-CC
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
38 Pilar Upfield · Acute kidney injury
ENC-00055 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “AKI”
N17.9		 criteria not met CC → removed
MS-DRG 377 → 377 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
39 Celeste Hartwell · Hyponatraemia
ENC-00098 · Hospital Medicine
In hospital: concurrent review		 Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 689 → 689 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
40 Celeste Hartwell · Malnutrition
ENC-00098 · Hospital Medicine
In hospital: concurrent review		 Clinical validation gap “severe protein-calorie malnutrition”
E43		 Moderate (non-severe) protein-calorie malnutrition (acute illness context)
E44.0 		MCC → CC
MS-DRG 689 → 689 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
41 Dmitri Dunmore · Malnutrition
ENC-00149 · Hospital Medicine
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “malnourished”
E46		 criteria not met CC → removed
MS-DRG 689 → 689 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
42 Nico Merriweather · Acute blood loss anaemia
ENC-00177 · Cardiology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “acute blood loss anemia”
D62		 Anemia (acute blood-loss criteria not met)
D64.9 		CC → non-CC
MS-DRG 291 → 291 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> non-CC
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
43 Nico Merriweather · Hyponatraemia
ENC-00177 · Cardiology
In hospital: concurrent review
Resident note awaiting attending cosign		 Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 291 → 291 (RW +0.0000)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)0.0illustrative relative-weight change +0.0000 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing15.0patient still in hospital (concurrent review)
Open
44 Florian Thorne · Acute kidney injury
ENC-00020 · Cardiology 		Clinical validation gap “acute kidney injury”
N17.9		 criteria not met CC → removed
MS-DRG 292 → 293 (RW -0.2830)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 8 days ago
Open
45 Jun Upfield · Acute kidney injury
ENC-00050 · Cardiology 		Clinical validation gap “AKI”
N17.9		 criteria not met CC → removed
MS-DRG 292 → 293 (RW -0.2830)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 12 days ago
Open
46 Zara Juniper · Hyponatraemia
ENC-00094 · Cardiology 		Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 292 → 293 (RW -0.2830)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 5 days ago
Open
47 Tobias Ivers · Hyponatraemia
ENC-00129 · Cardiology 		Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 292 → 293 (RW -0.2830)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 12 days ago
Open
48 Priya Ivers · Hyponatraemia
ENC-00150 · Cardiology 		Clinical validation gap “hyponatremia”
E87.1		 criteria not met CC → removed
MS-DRG 292 → 293 (RW -0.2830)
55
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level CC -> removed
Grouping change (illustrative)10.1illustrative relative-weight change -0.2830 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 6 days ago
Open
49 Camila Merriweather · Sepsis
ENC-00030 · Hospital Medicine
Contested definitions (Sepsis-2 vs Sepsis-3)		 Clinical validation gap “sepsis”
A41.9		 criteria not met principal → removed
MS-DRG 871 → 689 (RW -0.7822)
54
Priority score components
ComponentPointsWhy
Diagnosis-level change0.0secondary-diagnosis level principal -> removed
Grouping change (illustrative)25.0illustrative relative-weight change -0.7822 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing9.0discharged 2 day(s) ago
Open
50 Amara Merriweather · Heart failure
ENC-00053 · Pulmonology 		Clinical validation gap “acute on chronic diastolic heart failure”
I50.33		 Chronic diastolic (HFpEF) heart failure
I50.32 		MCC → CC
MS-DRG 190 → 191 (RW -0.2647)
54
Priority score components
ComponentPointsWhy
Diagnosis-level change20.0secondary-diagnosis level MCC -> CC
Grouping change (illustrative)9.4illustrative relative-weight change -0.2647 (absolute value ranks)
Evidence completeness20.0criteria fully applied
Timing4.5discharged 9 days ago
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.