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 | 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
|
Open | |||||||||||||||
| 2 | Priya Hartwell · Acute respiratory failure ENC-00170 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “hypoxia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 689 → 689 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 3 | Quinn Kestrel · Pressure injury ENC-00178 · Hospital Medicine In hospital: concurrent review |
Specificity gap | “sacral pressure ulcer” L89.159 |
Pressure injury of sacral region, stage 3 L89.153 |
non-CC → MCC MS-DRG 193 → 193 (RW +0.0000) |
75
|
Open | |||||||||||||||
| 4 | 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
|
Open | |||||||||||||||
| 5 | 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
|
Open | |||||||||||||||
| 6 | 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
|
Open | |||||||||||||||
| 7 | Luca Abernath · Heart failure ENC-00004 · Hospital Medicine |
Specificity gap | “diastolic heart failure” I50.30 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
CC → MCC MS-DRG 872 → 871 (RW +0.9192) |
70
|
Open | |||||||||||||||
| 8 | Pilar Ravensworth · Heart failure ENC-00022 · Hospital Medicine |
Specificity gap | “systolic heart failure” I50.20 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
CC → MCC MS-DRG 872 → 871 (RW +0.9192) |
70
|
Open | |||||||||||||||
| 9 | Mara Delacroix · Heart failure ENC-00109 · Hospital Medicine |
Specificity gap | “chronic diastolic heart failure” I50.32 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
CC → MCC MS-DRG 378 → 377 (RW +0.8473) |
70
|
Open | |||||||||||||||
| 10 | Yusuf Pemberton · Acute respiratory failure ENC-00126 · Hospital Medicine |
Specificity gap | not documented | Acute respiratory failure with hypoxia J96.01 |
— → MCC MS-DRG 193 → 193 (RW +0.0000) |
69
|
Open | |||||||||||||||
| 11 | 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
|
Open | |||||||||||||||
| 12 | 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
|
Open | |||||||||||||||
| 13 | 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
|
Open | |||||||||||||||
| 14 | Vera Rourke · Heart failure ENC-00157 · Hospital Medicine |
Specificity gap | “systolic heart failure” I50.20 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
CC → MCC MS-DRG 194 → 193 (RW +0.5085) |
67
|
Open | |||||||||||||||
| 15 | Uma Greaves · Acute respiratory failure ENC-00011 · Hospital Medicine |
Specificity gap | “hypoxia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 871 → 871 (RW +0.0000) |
64
|
Open | |||||||||||||||
| 16 | Kenji Galloway · Malnutrition ENC-00046 · Hospital Medicine |
Specificity gap | not documented | Severe protein-calorie malnutrition (acute illness context) E43 |
— → MCC MS-DRG 689 → 689 (RW +0.0000) |
64
|
Open | |||||||||||||||
| 17 | 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
|
Open | |||||||||||||||
| 18 | Tobias Fairbanks · Malnutrition ENC-00102 · Hospital Medicine |
Specificity gap | not documented | Severe protein-calorie malnutrition (acute illness context) E43 |
— → MCC MS-DRG 689 → 689 (RW +0.0000) |
64
|
Open | |||||||||||||||
| 19 | Bodhi Foxhall · Heart failure ENC-00122 · Hospital Medicine |
Specificity gap | “heart failure” I50.9 |
Acute systolic (HFrEF) heart failure I50.21 |
non-CC → MCC MS-DRG 689 → 689 (RW +0.0000) |
64
|
Open | |||||||||||||||
| 20 | Amara Greaves · Acute respiratory failure ENC-00138 · Hospital Medicine |
Specificity gap | “hypoxemia” R09.02 |
Acute respiratory failure with hypoxia J96.01 |
non-CC → MCC MS-DRG 871 → 871 (RW +0.0000) |
64
|
Open | |||||||||||||||
| 21 | Ximena Pemberton · Heart failure ENC-00159 · Pulmonology |
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) |
64
|
Open | |||||||||||||||
| 22 | Vera Penhallow · Heart failure ENC-00173 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “systolic heart failure” I50.20 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
CC → MCC MS-DRG 191 → 190 (RW +0.2647) |
64
|
Open | |||||||||||||||
| 23 | Esme Kestrel · Heart failure ENC-00007 · Hospital Medicine |
Specificity gap | “chronic systolic heart failure” I50.22 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
CC → MCC MS-DRG 194 → 193 (RW +0.5085) |
63
|
Open | |||||||||||||||
| 24 | 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
|
Open | |||||||||||||||
| 25 | Amara Yardley · Malnutrition ENC-00037 · Hospital Medicine |
Specificity gap | “malnutrition” E46 |
Severe protein-calorie malnutrition (chronic illness context) E43 |
CC → MCC MS-DRG 194 → 193 (RW +0.5085) |
63
|
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
|
Open | |||||||||||||||
| 27 | Viggo Elsworth · Malnutrition ENC-00079 · Hospital Medicine |
Specificity gap | “malnutrition” E46 |
Severe protein-calorie malnutrition (chronic illness context) E43 |
CC → MCC MS-DRG 194 → 193 (RW +0.5085) |
63
|
Open | |||||||||||||||
| 28 | 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
|
Open | |||||||||||||||
| 29 | Farah Juniper · Heart failure ENC-00141 · Hospital Medicine |
Specificity gap | “chronic diastolic heart failure” I50.32 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
CC → MCC MS-DRG 194 → 193 (RW +0.5085) |
63
|
Open | |||||||||||||||
| 30 | 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
|
Open | |||||||||||||||
| 31 | 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
|
Open | |||||||||||||||
| 32 | Keira Merriweather · Acute blood loss anaemia ENC-00064 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 195 → 194 (RW +0.1774) |
61
|
Open | |||||||||||||||
| 33 | 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
|
Open | |||||||||||||||
| 34 | 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
|
Open | |||||||||||||||
| 35 | 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
|
Open | |||||||||||||||
| 36 | 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
|
Open | |||||||||||||||
| 37 | 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
|
Open | |||||||||||||||
| 38 | Gideon Pemberton · Malnutrition ENC-00047 · Pulmonology |
Specificity gap | not documented | Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
— → CC MS-DRG 192 → 191 (RW +0.2010) |
56
|
Open | |||||||||||||||
| 39 | 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
|
Open | |||||||||||||||
| 40 | Lena Foxhall · Hyponatraemia ENC-00165 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 195 → 194 (RW +0.1774) |
55
|
Open | |||||||||||||||
| 41 | Teodora Vance · Acute kidney injury ENC-00001 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 42 | 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
|
Open | |||||||||||||||
| 43 | Marisol Okafor · Acute blood loss anaemia ENC-00009 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 378 → 378 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 44 | Rosalind Upfield · Chronic kidney disease ENC-00018 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 4 N18.4 |
non-CC → CC MS-DRG 872 → 872 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 45 | Sana Ingram · Acute kidney injury ENC-00027 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “worsening renal function” N28.9 |
Acute kidney injury (KDIGO stage 3) N17.9 |
non-CC → CC MS-DRG 191 → 191 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 46 | 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
|
Open | |||||||||||||||
| 47 | Sana Pemberton · Acute blood loss anaemia ENC-00039 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 292 → 292 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 48 | Vera Quillan · Acute blood loss anaemia ENC-00048 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 690 → 690 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 49 | Elena Okafor · Chronic kidney disease ENC-00054 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 4 N18.4 |
non-CC → CC MS-DRG 871 → 871 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 50 | Elena Okafor · Malnutrition ENC-00054 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “malnourished” E46 |
Severe protein-calorie malnutrition (acute illness context) E43 |
CC → MCC MS-DRG 871 → 871 (RW +0.0000) |
55
|
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.