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 | 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
|
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
|
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
|
Open | |||||||||||||||
| 4 | Keira Merriweather · Malnutrition ENC-00064 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Severe protein-calorie malnutrition (chronic illness context) E43 |
— → MCC MS-DRG 195 → 193 (RW +0.6859) |
100
|
Open | |||||||||||||||
| 5 | 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
|
Open | |||||||||||||||
| 6 | Celeste Marlow · Acute respiratory failure ENC-00101 · Hospital Medicine In hospital: concurrent review |
Specificity gap | “hypoxia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 195 → 193 (RW +0.6859) |
100
|
Open | |||||||||||||||
| 7 | 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
|
Open | |||||||||||||||
| 8 | Jalen Penhallow · Acute respiratory failure ENC-00083 · General Surgery |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 378 → 377 (RW +0.8473) |
94
|
Open | |||||||||||||||
| 9 | 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
|
Open | |||||||||||||||
| 10 | 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
|
Open | |||||||||||||||
| 11 | 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
|
Open | |||||||||||||||
| 12 | Ximena Hartwell · Pressure injury ENC-00166 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “sacral pressure ulcer” L89.159 |
Pressure injury of sacral region, stage 3 L89.153 |
non-CC → MCC MS-DRG 192 → 190 (RW +0.4657) |
92
|
Open | |||||||||||||||
| 13 | Sana Pemberton · Pressure injury ENC-00039 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Pressure injury of sacral region, stage 4 L89.154 |
— → MCC MS-DRG 292 → 291 (RW +0.4348) |
91
|
Open | |||||||||||||||
| 14 | Celeste Ravensworth · Acute respiratory failure ENC-00077 · Cardiology In hospital: concurrent review |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 292 → 291 (RW +0.4348) |
91
|
Open | |||||||||||||||
| 15 | 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
|
Open | |||||||||||||||
| 16 | Pilar Ravensworth · Acute respiratory failure ENC-00022 · Hospital Medicine |
Specificity gap | “hypoxemia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 872 → 871 (RW +0.9192) |
90
|
Open | |||||||||||||||
| 17 | Hana Abernath · Heart failure ENC-00062 · Hospital Medicine |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
non-CC → MCC MS-DRG 872 → 871 (RW +0.9192) |
90
|
Open | |||||||||||||||
| 18 | Hana Abernath · Acute respiratory failure ENC-00062 · Hospital Medicine |
Specificity gap | “hypoxemia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 872 → 871 (RW +0.9192) |
90
|
Open | |||||||||||||||
| 19 | Blake Emberly · Acute respiratory failure ENC-00070 · Cardiology |
Specificity gap | “hypoxemia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 293 → 291 (RW +0.7178) |
90
|
Open | |||||||||||||||
| 20 | Farah Elsworth · Heart failure ENC-00088 · Hospital Medicine |
Specificity gap | “heart failure” I50.9 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
non-CC → MCC MS-DRG 378 → 377 (RW +0.8473) |
90
|
Open | |||||||||||||||
| 21 | Farah Elsworth · Pressure injury ENC-00088 · Hospital Medicine |
Specificity gap | “sacral pressure ulcer” L89.159 |
Pressure injury of sacral region, stage 4 L89.154 |
non-CC → MCC MS-DRG 378 → 377 (RW +0.8473) |
90
|
Open | |||||||||||||||
| 22 | Farah Elsworth · Acute respiratory failure ENC-00088 · Hospital Medicine |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 378 → 377 (RW +0.8473) |
90
|
Open | |||||||||||||||
| 23 | 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
|
Open | |||||||||||||||
| 24 | Dmitri Galloway · Pressure injury ENC-00151 · General Surgery |
Specificity gap | “sacral pressure ulcer” L89.159 |
Pressure injury of sacral region, stage 4 L89.154 |
non-CC → MCC MS-DRG 378 → 377 (RW +0.8473) |
90
|
Open | |||||||||||||||
| 25 | Ximena Delacroix · Acute respiratory failure ENC-00161 · Cardiology |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 293 → 291 (RW +0.7178) |
90
|
Open | |||||||||||||||
| 26 | Wes Elsworth · Acute respiratory failure ENC-00024 · Hospital Medicine |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 195 → 193 (RW +0.6859) |
89
|
Open | |||||||||||||||
| 27 | Florian Nakashima · Heart failure ENC-00115 · Hospital Medicine |
Specificity gap | “CHF” I50.9 |
Acute systolic (HFrEF) heart failure I50.21 |
non-CC → MCC MS-DRG 195 → 193 (RW +0.6859) |
89
|
Open | |||||||||||||||
| 28 | Zara Penhallow · Acute respiratory failure ENC-00156 · Hospital Medicine In hospital: concurrent review |
Specificity gap | “hypoxia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 690 → 689 (RW +0.3508) |
88
|
Open | |||||||||||||||
| 29 | Nico Greaves · Acute respiratory failure ENC-00044 · Hospital Medicine |
Specificity gap | “hypoxia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 194 → 193 (RW +0.5085) |
87
|
Open | |||||||||||||||
| 30 | Nico Elsworth · Acute respiratory failure ENC-00025 · Cardiology |
Specificity gap | “hypoxia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 292 → 291 (RW +0.4348) |
85
|
Open | |||||||||||||||
| 31 | 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
|
Open | |||||||||||||||
| 32 | Zara Whitlock · Pressure injury ENC-00017 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “sacral decubitus ulcer” L89.159 |
Pressure injury of sacral region, stage 3 L89.153 |
non-CC → MCC MS-DRG 191 → 190 (RW +0.2647) |
84
|
Open | |||||||||||||||
| 33 | Sana Ingram · Pressure injury ENC-00027 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Pressure injury of sacral region, stage 4 L89.154 |
— → MCC MS-DRG 191 → 190 (RW +0.2647) |
84
|
Open | |||||||||||||||
| 34 | Keira Ravensworth · Heart failure ENC-00081 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
non-CC → MCC MS-DRG 191 → 190 (RW +0.2647) |
84
|
Open | |||||||||||||||
| 35 | Vera Penhallow · Acute respiratory failure ENC-00173 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “hypoxemia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 191 → 190 (RW +0.2647) |
84
|
Open | |||||||||||||||
| 36 | Nico Hartwell · Acute respiratory failure ENC-00032 · Hospital Medicine |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 194 → 193 (RW +0.5085) |
83
|
Open | |||||||||||||||
| 37 | Dario Nakashima · Acute respiratory failure ENC-00105 · Hospital Medicine |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 690 → 689 (RW +0.3508) |
82
|
Open | |||||||||||||||
| 38 | 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
|
Open | |||||||||||||||
| 39 | 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
|
Open | |||||||||||||||
| 40 | Sana Thorne · Malnutrition ENC-00107 · Cardiology |
Specificity gap | not documented | Severe protein-calorie malnutrition (acute illness context) E43 |
— → MCC MS-DRG 292 → 291 (RW +0.4348) |
80
|
Open | |||||||||||||||
| 41 | Dmitri Jessup · Acute respiratory failure ENC-00125 · Cardiology |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 292 → 291 (RW +0.4348) |
80
|
Open | |||||||||||||||
| 42 | Wes Upfield · Acute respiratory failure ENC-00006 · Pulmonology |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 191 → 190 (RW +0.2647) |
78
|
Open | |||||||||||||||
| 43 | 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
|
Open | |||||||||||||||
| 44 | Teodora Vance · Heart failure ENC-00001 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “CHF” I50.9 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
non-CC → MCC MS-DRG 193 → 193 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 45 | Jun Galloway · Heart failure ENC-00067 · Hospital Medicine In hospital: concurrent review |
Specificity gap | “heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
non-CC → MCC MS-DRG 193 → 193 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 46 | Ximena Bellweather · Acute respiratory failure ENC-00074 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 871 → 871 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 47 | Lena Northam · Heart failure ENC-00087 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
non-CC → MCC MS-DRG 871 → 871 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 48 | 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
|
Open | |||||||||||||||
| 49 | Mara Dunmore · Heart failure ENC-00116 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
non-CC → MCC MS-DRG 190 → 190 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 50 | 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
|
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.