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 | Avery Treadwell · Malnutrition ENC-00147 · Cardiology |
Specificity gap | “malnutrition” E46 |
Moderate (non-severe) protein-calorie malnutrition (acute illness context) E44.0 |
CC → CC MS-DRG 291 → 291 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 2 | Vera Rourke · Obesity ENC-00157 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 1 E66.811 |
— → non-CC MS-DRG 194 → 194 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 3 | Ines Ivers · Heart failure ENC-00158 · Cardiology |
Specificity gap | “chronic systolic heart failure” I50.22 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 4 | Ines Ivers · Obesity ENC-00158 · Cardiology |
Clinical validation gap | “morbid obesity” E66.01 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 292 → 292 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 5 | Lena Foxhall · Chronic kidney disease ENC-00165 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 195 → 195 (RW +0.0000) |
29
|
Open | |||||||||||||||
| 6 | Viggo Merriweather · Chronic kidney disease ENC-00171 · Hospital Medicine |
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) |
29
|
Open | |||||||||||||||
| 7 | Amara Whitlock · Heart failure ENC-00002 · Cardiology |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 8 | Rosalind Yardley · Obesity ENC-00008 · Hospital Medicine 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) |
24
|
Open | |||||||||||||||
| 9 | Rosalind Yardley · Pressure injury ENC-00008 · Hospital Medicine |
Specificity gap | “sacral decubitus ulcer” L89.159 |
Pressure injury of sacral region, stage 2 L89.152 |
non-CC → non-CC MS-DRG 871 → 871 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 10 | Greta Nakashima · Chronic kidney disease ENC-00028 · Hospital Medicine |
Specificity gap | not documented | Chronic kidney disease stage 3a N18.31 |
— → non-CC MS-DRG 871 → 871 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 11 | Marisol Abernath · Obesity ENC-00029 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 2 E66.812 |
— → non-CC MS-DRG 195 → 195 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 12 | Zara Brightwater · Obesity ENC-00034 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 2 E66.812 |
— → non-CC MS-DRG 377 → 377 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 13 | Wes Stavros · Obesity ENC-00038 · Pulmonology 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 191 → 191 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 14 | Marisol Thorne · Chronic kidney disease ENC-00042 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 15 | Vera Ravensworth · Heart failure ENC-00051 · Cardiology |
Specificity gap | “diastolic heart failure” I50.30 |
Chronic diastolic (HFpEF) heart failure I50.32 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 16 | Amara Merriweather · Chronic kidney disease ENC-00053 · Pulmonology |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 190 → 190 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 17 | Nadia Foxhall · Obesity ENC-00056 · 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 192 → 192 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 18 | Nadia Foxhall · Heart failure ENC-00059 · Cardiology |
Clinical validation gap | “acute on chronic diastolic heart failure” I50.33 |
Chronic diastolic (HFpEF) heart failure I50.32 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 19 | Nadia Foxhall · Obesity ENC-00059 · Cardiology 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 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 20 | Hana Abernath · Chronic kidney disease ENC-00062 · Hospital Medicine |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 872 → 872 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 21 | Yusuf Yardley · Malnutrition ENC-00068 · Hospital Medicine |
Specificity gap | “malnourished” E46 |
Moderate (non-severe) protein-calorie malnutrition (chronic illness context) E44.0 |
CC → CC MS-DRG 377 → 377 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 22 | Vera Fairbanks · Heart failure ENC-00069 · Cardiology |
Specificity gap | “congestive heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 23 | Blake Emberly · Heart failure ENC-00070 · Cardiology |
Specificity gap | “congestive heart failure” I50.9 |
Acute diastolic (HFpEF) heart failure I50.31 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 24 | Hana Upfield · Chronic kidney disease ENC-00072 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 25 | Hana Upfield · Obesity ENC-00072 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 1 E66.811 |
— → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 26 | Kenji Lindqvist · Chronic kidney disease ENC-00082 · Hospital Medicine |
Specificity gap | not documented | Chronic kidney disease stage 3b N18.32 |
— → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 27 | Dario Fairbanks · Obesity ENC-00093 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 1 E66.811 |
— → non-CC MS-DRG 690 → 690 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 28 | Zara Juniper · Chronic kidney disease ENC-00094 · Cardiology |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 29 | Ines Ashgrove · Heart failure ENC-00097 · Cardiology |
Specificity gap | “congestive heart failure” I50.9 |
Chronic systolic (HFrEF) heart failure I50.22 |
principal → principal MS-DRG 291 → 291 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 30 | Rafael Abernath · Heart failure ENC-00099 · Cardiology |
Specificity gap | “diastolic heart failure” I50.30 |
Chronic diastolic (HFpEF) heart failure I50.32 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 31 | Gideon Coldridge · Obesity ENC-00100 · Pulmonology |
Clinical validation gap | “class 3 obesity” E66.813 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 190 → 190 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 32 | Yusuf Whitlock · Obesity ENC-00114 · Hospital Medicine Model draft failed the query linter: edit before sending |
Specificity gap | not documented | Obesity, class 2 E66.812 |
— → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 33 | Florian Nakashima · Chronic kidney disease ENC-00115 · Hospital Medicine |
Specificity gap | “chronic kidney disease” N18.9 |
Chronic kidney disease stage 3a N18.31 |
non-CC → non-CC MS-DRG 195 → 195 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 34 | Dmitri Jessup · Heart failure ENC-00125 · Cardiology |
Specificity gap | “congestive heart failure” I50.9 |
Acute diastolic (HFpEF) heart failure I50.31 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 35 | Tobias Ivers · Heart failure ENC-00129 · Cardiology |
Clinical validation gap | “acute on chronic systolic heart failure” I50.23 |
Chronic systolic (HFrEF) heart failure I50.22 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 36 | Quinn Yardley · Heart failure ENC-00131 · Cardiology |
Specificity gap | “heart failure” I50.9 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 291 → 291 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 37 | Hana Quillan · Chronic kidney disease ENC-00133 · Hospital Medicine |
Specificity gap | not documented | Chronic kidney disease stage 3b N18.32 |
— → non-CC MS-DRG 689 → 689 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 38 | Florian Treadwell · Pressure injury ENC-00134 · Hospital Medicine |
Specificity gap | “sacral pressure ulcer” L89.159 |
Pressure injury of sacral region, unstageable L89.150 |
non-CC → non-CC MS-DRG 871 → 871 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 39 | Kenji Juniper · Obesity ENC-00135 · 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 689 → 689 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 40 | Amara Holloway · Chronic kidney disease ENC-00136 · Hospital Medicine |
Specificity gap | “CKD” N18.9 |
Chronic kidney disease stage 3b N18.32 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 41 | Amara Holloway · Obesity ENC-00136 · Hospital Medicine |
Clinical validation gap | “class 3 obesity” E66.813 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 194 → 194 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 42 | Hollis Kestrel · Heart failure ENC-00139 · Cardiology |
Specificity gap | “diastolic heart failure” I50.30 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 43 | Priya Ivers · Heart failure ENC-00150 · Cardiology |
Specificity gap | “chronic systolic heart failure” I50.22 |
Acute on chronic systolic (HFrEF) heart failure I50.23 |
principal → principal MS-DRG 292 → 292 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 44 | Dmitri Galloway · Obesity ENC-00151 · General Surgery 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 378 → 378 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 45 | Ximena Delacroix · Heart failure ENC-00161 · Cardiology |
Specificity gap | “CHF” I50.9 |
Acute diastolic (HFpEF) heart failure I50.31 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 46 | Quinn Northam · Heart failure ENC-00164 · Pulmonology |
Specificity gap | “HFrEF” I50.20 |
Chronic systolic (HFrEF) heart failure I50.22 |
CC → CC MS-DRG 191 → 191 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 47 | Quinn Northam · Obesity ENC-00164 · 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) |
24
|
Open | |||||||||||||||
| 48 | Blake Coldridge · Heart failure ENC-00175 · Cardiology |
Specificity gap | “heart failure” I50.9 |
Acute on chronic diastolic (HFpEF) heart failure I50.33 |
principal → principal MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 49 | Blake Coldridge · Obesity ENC-00175 · Cardiology |
Clinical validation gap | “class 3 obesity” E66.813 |
Obesity, class 1 E66.811 |
non-CC → non-CC MS-DRG 293 → 293 (RW +0.0000) |
24
|
Open | |||||||||||||||
| 50 | Zara Whitlock · Heart failure ENC-00017 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “heart failure” I50.9 |
clinician judgement | non-CC → — MS-DRG 191 → 191 (RW +0.0000) |
21
|
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.