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 | Ximena Kestrel · Chronic kidney disease ENC-00152 · Cardiology |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 4 N18.4 |
non-CC → CC MS-DRG 291 → 291 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 2 | Ximena Kestrel · Hyponatraemia ENC-00152 · Cardiology |
Clinical validation gap | “hyponatremia” E87.1 |
criteria not met | CC → removed MS-DRG 291 → 291 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 3 | Vera Rourke · Acute kidney injury ENC-00157 · Hospital Medicine |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 3) N17.9 |
non-CC → CC MS-DRG 194 → 194 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 4 | Vera Rourke · Acute blood loss anaemia ENC-00157 · Hospital Medicine |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 194 → 194 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 5 | Lena Lindqvist · Acute blood loss anaemia ENC-00174 · Hospital Medicine |
Clinical validation gap | “acute blood loss anemia” D62 |
Anemia (acute blood-loss criteria not met) D64.9 |
CC → non-CC MS-DRG 377 → 377 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 6 | Lena Lindqvist · Malnutrition ENC-00174 · Hospital Medicine |
Specificity gap | not documented | Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
— → CC MS-DRG 377 → 377 (RW +0.0000) |
49
|
Open | |||||||||||||||
| 7 | Greta Nakashima · Sepsis ENC-00028 · Hospital Medicine Contested definitions (Sepsis-2 vs Sepsis-3) |
Clinical validation gap | “sepsis” A41.9 |
criteria not met | principal → removed MS-DRG 871 → 193 (RW -0.6281) |
47
|
Open | |||||||||||||||
| 8 | Uma Quillan · Obesity ENC-00142 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 3 E66.813 |
— → non-CC MS-DRG 293 → 292 (RW +0.2830) |
45
|
Open | |||||||||||||||
| 9 | Amara Whitlock · Acute kidney injury ENC-00002 · Cardiology |
Clinical validation gap | “acute kidney injury” N17.9 |
criteria not met | CC → removed MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 10 | Camila Lindqvist · Acute kidney injury ENC-00003 · Cardiology |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 3) N17.9 |
non-CC → CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 11 | Luca Abernath · Hyponatraemia ENC-00004 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (moderate) E87.1 |
— → CC MS-DRG 872 → 872 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 12 | Esme Kestrel · Acute blood loss anaemia ENC-00007 · Hospital Medicine |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 13 | Florian Thorne · Acute blood loss anaemia ENC-00020 · Cardiology |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 14 | Pilar Ravensworth · Hyponatraemia ENC-00022 · Hospital Medicine |
Clinical validation gap | “hyponatremia” E87.1 |
criteria not met | CC → removed MS-DRG 872 → 872 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 15 | Jalen Sallow · Heart failure ENC-00026 · Hospital Medicine |
Specificity gap | “CHF” I50.9 |
Chronic diastolic (HFpEF) heart failure I50.32 |
non-CC → CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 16 | Greta Nakashima · Acute kidney injury ENC-00028 · Hospital Medicine |
Clinical validation gap | “AKI” N17.9 |
criteria not met | CC → removed MS-DRG 871 → 871 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 17 | Greta Nakashima · Malnutrition ENC-00028 · 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 871 → 871 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 18 | Nico Hartwell · Acute kidney injury ENC-00032 · Hospital Medicine |
Clinical validation gap | “acute kidney injury” N17.9 |
criteria not met | CC → removed MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 19 | Amara Yardley · Acute kidney injury ENC-00037 · Hospital Medicine |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 2) N17.9 |
— → CC MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 20 | Nadia Larkspur · Acute kidney injury ENC-00040 · Cardiology |
Specificity gap | “acute renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 1) N17.9 |
non-CC → CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 21 | Ines Nakashima · Hyponatraemia ENC-00041 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (moderate) E87.1 |
— → CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 22 | Marisol Thorne · Acute kidney injury ENC-00042 · Hospital Medicine |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 2) N17.9 |
— → CC MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 23 | Marisol Thorne · Malnutrition ENC-00042 · Hospital Medicine |
Specificity gap | not documented | Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
— → CC MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 24 | Nico Ravensworth · Hyponatraemia ENC-00043 · Cardiology |
Clinical validation gap | “hyponatremia” E87.1 |
criteria not met | CC → removed MS-DRG 291 → 291 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 25 | Nico Ravensworth · Malnutrition ENC-00043 · Cardiology |
Clinical validation gap | “malnourished” E46 |
criteria not met | CC → removed MS-DRG 291 → 291 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 26 | Kenji Galloway · Acute kidney injury ENC-00046 · Hospital Medicine |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 1) N17.9 |
— → CC MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 27 | Kenji Galloway · Acute blood loss anaemia ENC-00046 · Hospital Medicine |
Clinical validation gap | “acute blood loss anemia” D62 |
Anemia (acute blood-loss criteria not met) D64.9 |
CC → non-CC MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 28 | Ximena Vance · Acute kidney injury ENC-00049 · Hospital Medicine |
Clinical validation gap | “acute kidney injury” N17.9 |
criteria not met | CC → removed MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 29 | Ximena Vance · Acute blood loss anaemia ENC-00049 · Hospital Medicine |
Clinical validation gap | “acute blood loss anemia” D62 |
Anemia (acute blood-loss criteria not met) D64.9 |
CC → non-CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 30 | Jun Upfield · Acute blood loss anaemia ENC-00050 · Cardiology |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 31 | Amara Merriweather · Acute kidney injury ENC-00053 · Pulmonology |
Specificity gap | “acute renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 1) N17.9 |
non-CC → CC MS-DRG 190 → 190 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 32 | Hana Abernath · Malnutrition ENC-00062 · Hospital Medicine |
Clinical validation gap | “malnourished” E46 |
criteria not met | CC → removed MS-DRG 872 → 872 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 33 | Yusuf Yardley · Acute blood loss anaemia ENC-00068 · Hospital Medicine |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 377 → 377 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 34 | Hana Upfield · Acute blood loss anaemia ENC-00072 · Hospital Medicine |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 35 | Camila Upfield · Heart failure ENC-00085 · Hospital Medicine |
Specificity gap | “HFrEF” I50.20 |
Acute systolic (HFrEF) heart failure I50.21 |
CC → MCC MS-DRG 871 → 871 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 36 | Farah Nakashima · Malnutrition ENC-00090 · Cardiology |
Clinical validation gap | “malnourished” E46 |
criteria not met | CC → removed MS-DRG 291 → 291 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 37 | Pilar Kestrel · Chronic kidney disease ENC-00092 · Hospital Medicine |
Specificity gap | not documented | Chronic kidney disease stage 4 N18.4 |
— → CC MS-DRG 871 → 871 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 38 | Dario Fairbanks · Chronic kidney disease ENC-00093 · Hospital Medicine |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 4 N18.4 |
non-CC → CC MS-DRG 690 → 690 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 39 | Gideon Coldridge · Chronic kidney disease ENC-00100 · Pulmonology |
Clinical validation gap | “CKD stage 4” N18.4 |
Chronic kidney disease stage 3b N18.32 |
CC → non-CC MS-DRG 190 → 190 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 40 | Tobias Fairbanks · Chronic kidney disease ENC-00102 · Hospital Medicine |
Clinical validation gap | “CKD stage 4” N18.4 |
Chronic kidney disease stage 3b N18.32 |
CC → non-CC MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 41 | Sana Thorne · Acute kidney injury ENC-00107 · Cardiology |
Clinical validation gap | “AKI” N17.9 |
criteria not met | CC → removed MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 42 | Sana Thorne · Chronic kidney disease ENC-00107 · Cardiology |
Clinical validation gap | “CKD stage 4” N18.4 |
Chronic kidney disease stage 3b N18.32 |
CC → non-CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 43 | Wes Hartwell · Acute kidney injury ENC-00111 · Hospital Medicine |
Specificity gap | “worsening renal function” N28.9 |
Acute kidney injury (KDIGO stage 1) N17.9 |
non-CC → CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 44 | Yusuf Whitlock · Acute kidney injury ENC-00114 · Hospital Medicine |
Clinical validation gap | “AKI” N17.9 |
criteria not met | CC → removed MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 45 | Yusuf Whitlock · Acute blood loss anaemia ENC-00114 · Hospital Medicine |
Clinical validation gap | “acute blood loss anemia” D62 |
Anemia (acute blood-loss criteria not met) D64.9 |
CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 46 | Bodhi Foxhall · Acute kidney injury ENC-00122 · Hospital Medicine |
Clinical validation gap | “AKI” N17.9 |
criteria not met | CC → removed MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 47 | Bodhi Foxhall · Acute blood loss anaemia ENC-00122 · Hospital Medicine |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 48 | Bodhi Foxhall · Malnutrition ENC-00122 · Hospital Medicine |
Clinical validation gap | “severe malnutrition” E43 |
Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
MCC → CC MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 49 | Dmitri Marlow · Hyponatraemia ENC-00123 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 50 | Dmitri Jessup · Acute blood loss anaemia ENC-00125 · Cardiology |
Clinical validation gap | “acute blood loss anemia” D62 |
Anemia (acute blood-loss criteria not met) D64.9 |
CC → non-CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
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.