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 | Odette Brightwater · Acute blood loss anaemia ENC-00127 · Hospital Medicine |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 871 → 871 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 2 | Tobias Ivers · Acute blood loss anaemia ENC-00129 · Cardiology |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 292 → 292 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 3 | Nico Bellweather · Acute blood loss anaemia ENC-00130 · Hospital Medicine |
Specificity gap | not documented | Acute blood loss anemia D62 |
— → CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 4 | Quinn Yardley · Hyponatraemia ENC-00131 · Cardiology |
Specificity gap | not documented | Hyponatraemia (profound) E87.1 |
— → CC MS-DRG 291 → 291 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 5 | Florian Treadwell · Acute kidney injury ENC-00134 · Hospital Medicine |
Specificity gap | “renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 871 → 871 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 6 | Kenji Juniper · Heart failure ENC-00135 · Hospital Medicine |
Specificity gap | “diastolic heart failure” I50.30 |
Acute diastolic (HFpEF) heart failure I50.31 |
CC → MCC MS-DRG 689 → 689 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 7 | Esme Bellweather · Acute kidney injury ENC-00148 · Hospital Medicine |
Specificity gap | not documented | Acute kidney injury (KDIGO stage 1) N17.9 |
— → CC MS-DRG 193 → 193 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 8 | Dmitri Galloway · Acute blood loss anaemia ENC-00151 · General Surgery |
Clinical validation gap | “acute blood loss anemia” D62 |
Anemia (acute blood-loss criteria not met) D64.9 |
CC → non-CC MS-DRG 378 → 378 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 9 | Ximena Pemberton · Acute blood loss anaemia ENC-00159 · Pulmonology |
Specificity gap | “anemia” D64.9 |
Acute blood loss anemia D62 |
non-CC → CC MS-DRG 190 → 190 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 10 | Nadia Greaves · Chronic kidney disease ENC-00162 · Hospital Medicine |
Clinical validation gap | “CKD stage 4” N18.4 |
Chronic kidney disease stage 3b N18.32 |
CC → non-CC MS-DRG 690 → 690 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 11 | Nadia Greaves · Hyponatraemia ENC-00162 · Hospital Medicine |
Specificity gap | not documented | Hyponatraemia (mild) E87.1 |
— → CC MS-DRG 690 → 690 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 12 | Celeste Okafor · Acute kidney injury ENC-00172 · Hospital Medicine |
Specificity gap | “acute renal insufficiency” N28.9 |
Acute kidney injury (KDIGO stage 2) N17.9 |
non-CC → CC MS-DRG 690 → 690 (RW +0.0000) |
44
|
Open | |||||||||||||||
| 13 | Ximena Hartwell · Obesity ENC-00166 · Pulmonology 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 192 → 191 (RW +0.2010) |
42
|
Open | |||||||||||||||
| 14 | Teodora Vance · Chronic kidney disease ENC-00001 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 193 → 193 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 15 | Gideon Merriweather · Obesity ENC-00005 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical validation gap | “class 3 obesity” E66.813 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 193 → 193 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 16 | Marisol Okafor · Malnutrition ENC-00009 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “malnourished” E46 |
Moderate (non-severe) protein-calorie malnutrition (chronic illness context) E44.0 |
CC → CC MS-DRG 378 → 378 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 17 | Rosalind Upfield · Pressure injury ENC-00018 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “sacral decubitus ulcer” L89.159 |
Pressure injury of sacral region, unstageable L89.150 |
non-CC → non-CC MS-DRG 872 → 872 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 18 | Vera Quillan · Malnutrition ENC-00048 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “malnutrition” E46 |
Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
CC → CC MS-DRG 690 → 690 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 19 | Luca Greaves · Heart failure ENC-00057 · Cardiology In hospital: concurrent review |
Specificity gap | “diastolic heart failure” I50.30 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 20 | Mara Pemberton · Sepsis ENC-00061 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign Contested definitions (Sepsis-2 vs Sepsis-3) |
Specificity gap | “sepsis” A41.9 |
Sepsis with septic shock R65.21 |
principal → principal MS-DRG 871 → ? |
35
|
Open | |||||||||||||||
| 21 | Jun Galloway · Obesity ENC-00067 · Hospital Medicine In hospital: concurrent review Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 3 E66.813 |
non-CC → non-CC MS-DRG 193 → 193 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 22 | Ximena Bellweather · Obesity ENC-00074 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 3 E66.813 |
non-CC → non-CC MS-DRG 871 → 871 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 23 | Celeste Ravensworth · Heart failure ENC-00077 · Cardiology In hospital: concurrent review |
Specificity gap | “systolic heart failure” I50.20 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 24 | Priya Nakashima · Chronic kidney disease ENC-00080 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Chronic kidney disease stage 3a N18.31 |
— → non-CC MS-DRG 291 → 291 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 25 | Priya Nakashima · Heart failure ENC-00080 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “chronic systolic heart failure” I50.22 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 291 → 291 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 26 | Priya Nakashima · Obesity ENC-00080 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical validation gap | “morbid obesity” E66.01 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 291 → 291 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 27 | Lena Northam · Chronic kidney disease ENC-00087 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 871 → 871 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 28 | Lena Northam · Obesity ENC-00087 · Hospital Medicine 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 871 → 871 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 29 | Celeste Marlow · Chronic kidney disease ENC-00101 · Hospital Medicine In hospital: concurrent review |
Specificity gap | “CKD stage 3” N18.30 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 195 → 195 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 30 | Kenji Oyelaran · Obesity ENC-00103 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 3 E66.813 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 31 | Dmitri Greaves · Chronic kidney disease ENC-00106 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | not documented | Chronic kidney disease stage 3a N18.31 |
— → non-CC MS-DRG 689 → 689 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 32 | Dmitri Greaves · Malnutrition ENC-00106 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “malnourished” E46 |
Moderate (non-severe) protein-calorie malnutrition (chronic illness context) E44.0 |
CC → CC MS-DRG 689 → 689 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 33 | Silas Dunmore · Chronic kidney disease ENC-00137 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 193 → 193 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 34 | Silas Dunmore · Obesity ENC-00137 · Hospital Medicine 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 193 → 193 (RW +0.0000) |
35
|
Open | |||||||||||||||
| 35 | Luca Abernath · Sepsis ENC-00004 · Hospital Medicine Contested definitions (Sepsis-2 vs Sepsis-3) |
Clinical validation gap | “sepsis” A41.9 |
criteria not met | principal → removed MS-DRG 872 → 690 (RW -0.2138) |
32
|
Open | |||||||||||||||
| 36 | Orrin Foxhall · Sepsis ENC-00063 · Hospital Medicine Contested definitions (Sepsis-2 vs Sepsis-3) |
Clinical validation gap | “sepsis” A41.9 |
criteria not met | principal → removed MS-DRG 872 → 690 (RW -0.2138) |
32
|
Open | |||||||||||||||
| 37 | Wes Upfield · Obesity ENC-00006 · Pulmonology Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 191 → 191 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 38 | Dario Ingram · Obesity ENC-00019 · Hospital Medicine |
Clinical validation gap | “morbid obesity” E66.01 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 377 → 377 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 39 | Nico Elsworth · Heart failure ENC-00025 · Cardiology |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 40 | Camila Merriweather · Obesity ENC-00030 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 871 → 871 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 41 | Gideon Ashgrove · Obesity ENC-00031 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | “obesity” E66.9 |
Obesity, class 2 E66.812 |
non-CC → non-CC MS-DRG 378 → 378 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 42 | Nico Greaves · Chronic kidney disease ENC-00044 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 43 | Kenji Galloway · Chronic kidney disease ENC-00058 · Cardiology |
Specificity gap | not documented | Chronic kidney disease stage 3a N18.31 |
— → non-CC MS-DRG 292 → 292 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 44 | Kenji Galloway · Heart failure ENC-00058 · Cardiology |
Specificity gap | “chronic diastolic heart failure” I50.32 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 45 | Pilar Lindqvist · Chronic kidney disease ENC-00073 · Hospital Medicine |
Specificity gap | not documented | Chronic kidney disease stage 3b N18.32 |
— → non-CC MS-DRG 194 → 194 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 46 | Pilar Lindqvist · Malnutrition ENC-00073 · Hospital Medicine |
Specificity gap | “malnutrition” E46 |
Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
CC → CC MS-DRG 194 → 194 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 47 | Silas Coldridge · Chronic kidney disease ENC-00091 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 193 → 193 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 48 | Odette Elsworth · Heart failure ENC-00108 · Cardiology |
Specificity gap | “chronic systolic heart failure” I50.22 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 291 → 291 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 49 | Nico Holloway · Chronic kidney disease ENC-00144 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 50 | Avery Treadwell · Heart failure ENC-00147 · Cardiology |
Specificity gap | “CHF” I50.9 |
Acute diastolic (HFpEF) heart failure I50.31 |
principal → principal MS-DRG 291 → 291 (RW +0.0000) |
29
|
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.