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 | 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
|
Open | |||||||||||||||
| 2 | Florian Quillan · Acute kidney injury ENC-00060 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “acute renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 194 → 194 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 3 | Mara Pemberton · Malnutrition ENC-00061 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
— → CC MS-DRG 871 → 871 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 4 | Lena Upfield · Acute blood loss anaemia ENC-00065 · 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 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 5 | Lena Upfield · Chronic kidney disease ENC-00065 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 4 N18.4 |
non-CC → CC MS-DRG 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 6 | Lena Upfield · Heart failure ENC-00065 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “diastolic heart failure” I50.30 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
CC → MCC MS-DRG 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 7 | Lena Upfield · Hyponatraemia ENC-00065 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Hyponatraemia (moderate) E87.1 |
— → CC MS-DRG 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 8 | Jun Galloway · Hyponatraemia ENC-00067 · Hospital Medicine In hospital: concurrent review |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 9 | Celeste Ravensworth · Acute blood loss anaemia ENC-00077 · Cardiology In hospital: concurrent review |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 292 → 292 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 10 | Viggo Pemberton · Acute kidney injury ENC-00095 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 3) N17.9 |
— → CC MS-DRG 292 → 292 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 11 | Celeste Hartwell · Acute kidney injury ENC-00098 · Hospital Medicine In hospital: concurrent review |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 2) N17.9 |
— → CC MS-DRG 689 → 689 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 12 | 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
|
Open | |||||||||||||||
| 13 | 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
|
Open | |||||||||||||||
| 14 | Jun Kestrel · Acute kidney injury ENC-00124 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 2) N17.9 |
— → CC MS-DRG 190 → 190 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 15 | Esme Northam · Acute blood loss anaemia ENC-00128 · Hospital Medicine In hospital: concurrent review |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 378 → 378 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 16 | 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
|
Open | |||||||||||||||
| 17 | Lena Okafor · Acute blood loss anaemia ENC-00169 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 377 → 377 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 18 | Vera Penhallow · Hyponatraemia ENC-00173 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 191 → 191 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 19 | 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
|
Open | |||||||||||||||
| 20 | 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
|
Open | |||||||||||||||
| 21 | Quinn Kestrel · Acute kidney injury ENC-00178 · Hospital Medicine In hospital: concurrent review |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 3) N17.9 |
non-CC → CC MS-DRG 193 → 193 (RW +0.0000) |
55
|
Open | |||||||||||||||
| 22 | 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
|
Open | |||||||||||||||
| 23 | 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
|
Open | |||||||||||||||
| 24 | Vera Fairbanks · Acute kidney injury ENC-00069 · Cardiology |
Specificity gap | “acute renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 1) N17.9 |
non-CC → CC MS-DRG 293 → 292 (RW +0.2830) |
55
|
Open | |||||||||||||||
| 25 | Blake Emberly · Acute kidney injury ENC-00070 · Cardiology |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 3) N17.9 |
— → CC MS-DRG 293 → 292 (RW +0.2830) |
55
|
Open | |||||||||||||||
| 26 | 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
|
Open | |||||||||||||||
| 27 | 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
|
Open | |||||||||||||||
| 28 | Hollis Kestrel · Hyponatraemia ENC-00139 · Cardiology |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 293 → 292 (RW +0.2830) |
55
|
Open | |||||||||||||||
| 29 | 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
|
Open | |||||||||||||||
| 30 | Ximena Delacroix · Acute kidney injury ENC-00161 · Cardiology |
Specificity gap | “acute renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 293 → 292 (RW +0.2830) |
55
|
Open | |||||||||||||||
| 31 | 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
|
Open | |||||||||||||||
| 32 | Wes Stavros · Heart failure ENC-00038 · Pulmonology |
Specificity gap | “HFrEF” I50.20 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
CC → MCC MS-DRG 191 → 190 (RW +0.2647) |
54
|
Open | |||||||||||||||
| 33 | 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
|
Open | |||||||||||||||
| 34 | Gideon Coldridge · Heart failure ENC-00100 · Pulmonology |
Clinical validation gap | “acute on chronic systolic heart failure” I50.23 |
Chronic systolic (HFrEF) heart failure I50.22 |
MCC → CC MS-DRG 190 → 191 (RW -0.2647) |
54
|
Open | |||||||||||||||
| 35 | Nadia Foxhall · Acute kidney injury ENC-00056 · Pulmonology |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 2) N17.9 |
— → CC MS-DRG 192 → 191 (RW +0.2010) |
52
|
Open | |||||||||||||||
| 36 | Nadia Foxhall · Hyponatraemia ENC-00056 · Pulmonology |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 192 → 191 (RW +0.2010) |
52
|
Open | |||||||||||||||
| 37 | Marisol Abernath · Acute kidney injury ENC-00029 · Hospital Medicine |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 195 → 194 (RW +0.1774) |
51
|
Open | |||||||||||||||
| 38 | Pilar Nakashima · Acute kidney injury ENC-00045 · Hospital Medicine |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 1) N17.9 |
non-CC → CC MS-DRG 195 → 194 (RW +0.1774) |
51
|
Open | |||||||||||||||
| 39 | Kenji Lindqvist · Acute kidney injury ENC-00082 · Hospital Medicine |
Clinical validation gap | “AKI” N17.9 |
criteria not met | CC → removed MS-DRG 194 → 195 (RW -0.1774) |
51
|
Open | |||||||||||||||
| 40 | Florian Nakashima · Acute kidney injury ENC-00115 · Hospital Medicine |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 3) N17.9 |
non-CC → CC MS-DRG 195 → 194 (RW +0.1774) |
51
|
Open | |||||||||||||||
| 41 | Jun Ivers · Hyponatraemia ENC-00145 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 195 → 194 (RW +0.1774) |
51
|
Open | |||||||||||||||
| 42 | Odette Brightwater · Sepsis ENC-00127 · Hospital Medicine 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) |
50
|
Open | |||||||||||||||
| 43 | Orrin Treadwell · Hyponatraemia ENC-00016 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (moderate) E87.1 |
— → CC MS-DRG 690 → 690 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 44 | Camila Merriweather · Chronic kidney disease ENC-00030 · Hospital Medicine |
Specificity gap | not documented | Chronic kidney disease stage 4 N18.4 |
— → CC MS-DRG 871 → 871 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 45 | Nico Greaves · Acute kidney injury ENC-00044 · Hospital Medicine |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 194 → 194 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 46 | Pilar Lindqvist · Acute kidney injury ENC-00073 · Hospital Medicine |
Clinical validation gap | “AKI” N17.9 |
criteria not met | CC → removed MS-DRG 194 → 194 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 47 | Jalen Penhallow · Acute blood loss anaemia ENC-00083 · General Surgery |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 378 → 378 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 48 | Odette Elsworth · Acute kidney injury ENC-00108 · Cardiology |
Clinical validation gap | “acute kidney injury” N17.9 |
criteria not met | CC → removed MS-DRG 291 → 291 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 49 | Odette Elsworth · Hyponatraemia ENC-00108 · Cardiology |
Specificity gap | not documented | Hyponatraemia (moderate) E87.1 |
— → CC MS-DRG 291 → 291 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 50 | Ximena Kestrel · Acute kidney injury ENC-00152 · Cardiology |
Clinical validation gap | “acute kidney injury” N17.9 |
criteria not met | CC → removed MS-DRG 291 → 291 (RW +0.0000) |
49
|
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.