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 | Rosalind Upfield · Acute blood loss anaemia ENC-00018 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 872 → 872 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 2 | Farah Penhallow · Heart failure ENC-00035 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “CHF” I50.9 |
clinician judgement | non-CC → — MS-DRG 195 → 195 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 3 | Sana Pemberton · Malnutrition ENC-00039 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “malnutrition” E46 |
clinician judgement | CC → — MS-DRG 292 → 292 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 4 | Pilar Upfield · Acute blood loss anaemia ENC-00055 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 377 → 377 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 5 | Florian Quillan · Hyponatraemia ENC-00060 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “hyponatremia” E87.1 |
clinician judgement | CC → — MS-DRG 194 → 194 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 6 | Mara Pemberton · Hyponatraemia ENC-00061 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “hyponatremia” E87.1 |
clinician judgement | CC → — MS-DRG 871 → 871 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 7 | Lena Upfield · Acute respiratory failure ENC-00065 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “hypoxemia” R09.02 |
clinician judgement | non-CC → — MS-DRG 193 → 193 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 8 | Keira Ravensworth · Acute respiratory failure ENC-00081 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “hypoxia” R09.02 |
clinician judgement | non-CC → — MS-DRG 191 → 191 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 9 | Viggo Pemberton · Acute respiratory failure ENC-00095 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “hypoxemia” R09.02 |
clinician judgement | non-CC → — MS-DRG 292 → 292 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 10 | Kenji Oyelaran · Acute blood loss anaemia ENC-00103 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 194 → 194 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 11 | Gideon Whitlock · Acute respiratory failure ENC-00104 · Cardiology In hospital: concurrent review |
Clinical judgement required | “hypoxia” R09.02 |
clinician judgement | non-CC → — MS-DRG 293 → 293 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 12 | Dmitri Greaves · Hyponatraemia ENC-00106 · Hospital Medicine In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “hyponatremia” E87.1 |
clinician judgement | CC → — MS-DRG 689 → 689 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 13 | Mara Dunmore · Malnutrition ENC-00116 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “malnourished” E46 |
clinician judgement | CC → — MS-DRG 190 → 190 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 14 | Ximena Hartwell · Acute kidney injury ENC-00166 · Pulmonology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | not documented | clinician judgement | — → — MS-DRG 192 → 192 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 15 | Florian Yardley · Heart failure ENC-00176 · Cardiology In hospital: concurrent review Resident note awaiting attending cosign |
Clinical judgement required | “heart failure” I50.9 |
clinician judgement | principal → — MS-DRG 292 → 292 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 16 | Quinn Kestrel · Acute blood loss anaemia ENC-00178 · Hospital Medicine In hospital: concurrent review |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 193 → 193 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 17 | Quinn Kestrel · Malnutrition ENC-00178 · Hospital Medicine In hospital: concurrent review |
Clinical judgement required | “malnourished” E46 |
clinician judgement | CC → — MS-DRG 193 → 193 (RW +0.0000) |
21
|
Open | |||||||||||||||
| 18 | Orrin Treadwell · Acute blood loss anaemia ENC-00016 · Hospital Medicine |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 690 → 690 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 19 | Dario Ingram · Acute blood loss anaemia ENC-00019 · Hospital Medicine |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 377 → 377 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 20 | Florian Yardley · Acute kidney injury ENC-00023 · Cardiology |
Clinical judgement required | not documented | clinician judgement | — → — MS-DRG 293 → 293 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 21 | Florian Yardley · Heart failure ENC-00023 · Cardiology |
Clinical judgement required | “CHF” I50.9 |
clinician judgement | principal → — MS-DRG 293 → 293 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 22 | Ines Ivers · Acute respiratory failure ENC-00158 · Cardiology |
Clinical judgement required | “hypoxemia” R09.02 |
clinician judgement | non-CC → — MS-DRG 292 → 292 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 23 | Lena Foxhall · Acute respiratory failure ENC-00165 · Hospital Medicine |
Clinical judgement required | “hypoxemia” R09.02 |
clinician judgement | non-CC → — MS-DRG 195 → 195 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 24 | Lena Lindqvist · Acute kidney injury ENC-00174 · Hospital Medicine |
Clinical judgement required | not documented | clinician judgement | — → — MS-DRG 377 → 377 (RW +0.0000) |
15
|
Open | |||||||||||||||
| 25 | Amara Whitlock · Hyponatraemia ENC-00002 · Cardiology |
Clinical judgement required | “hyponatremia” E87.1 |
clinician judgement | CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 26 | Amara Whitlock · Malnutrition ENC-00002 · Cardiology |
Clinical judgement required | “malnourished” E46 |
clinician judgement | CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 27 | Camila Lindqvist · Heart failure ENC-00003 · Cardiology |
Clinical judgement required | “congestive heart failure” I50.9 |
clinician judgement | principal → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 28 | Camila Lindqvist · Malnutrition ENC-00003 · Cardiology |
Clinical judgement required | “malnutrition” E46 |
clinician judgement | CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 29 | Rosalind Yardley · Acute respiratory failure ENC-00008 · Hospital Medicine |
Clinical judgement required | “hypoxia” R09.02 |
clinician judgement | non-CC → — MS-DRG 871 → 871 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 30 | Wes Elsworth · Chronic kidney disease ENC-00024 · Hospital Medicine |
Clinical judgement required | “CKD stage 3a” N18.31 |
clinician judgement | non-CC → — MS-DRG 195 → 195 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 31 | Nico Hartwell · Malnutrition ENC-00032 · Hospital Medicine |
Clinical judgement required | “malnutrition” E46 |
clinician judgement | CC → — MS-DRG 194 → 194 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 32 | Amara Yardley · Heart failure ENC-00037 · Hospital Medicine |
Clinical judgement required | “congestive heart failure” I50.9 |
clinician judgement | non-CC → — MS-DRG 194 → 194 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 33 | Nadia Larkspur · Heart failure ENC-00040 · Cardiology |
Clinical judgement required | “CHF” I50.9 |
clinician judgement | principal → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 34 | Ines Nakashima · Heart failure ENC-00041 · Hospital Medicine |
Clinical judgement required | “heart failure” I50.9 |
clinician judgement | non-CC → — MS-DRG 193 → 193 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 35 | Marisol Thorne · Hyponatraemia ENC-00042 · Hospital Medicine |
Clinical judgement required | “hyponatremia” E87.1 |
clinician judgement | CC → — MS-DRG 194 → 194 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 36 | Nico Ravensworth · Heart failure ENC-00043 · Cardiology |
Clinical judgement required | “CHF” I50.9 |
clinician judgement | principal → — MS-DRG 291 → 291 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 37 | Pilar Nakashima · Acute respiratory failure ENC-00045 · Hospital Medicine |
Clinical judgement required | “hypoxemia” R09.02 |
clinician judgement | non-CC → — MS-DRG 195 → 195 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 38 | Jun Upfield · Chronic kidney disease ENC-00050 · Cardiology |
Clinical judgement required | “CKD stage 3a” N18.31 |
clinician judgement | non-CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 39 | Yusuf Yardley · Acute kidney injury ENC-00068 · Hospital Medicine |
Clinical judgement required | not documented | clinician judgement | — → — MS-DRG 377 → 377 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 40 | Viggo Elsworth · Acute kidney injury ENC-00079 · Hospital Medicine |
Clinical judgement required | “acute renal insufficiency” N28.9 |
clinician judgement | non-CC → — MS-DRG 194 → 194 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 41 | Farah Elsworth · Acute blood loss anaemia ENC-00088 · Hospital Medicine |
Clinical judgement required | “acute blood loss anemia” D62 |
clinician judgement | CC → — MS-DRG 378 → 378 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 42 | Pilar Kestrel · Sepsis ENC-00092 · Hospital Medicine Contested definitions (Sepsis-2 vs Sepsis-3) |
Clinical judgement required | “sepsis” A41.9 |
clinician judgement | principal → — MS-DRG 871 → 871 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 43 | Dario Fairbanks · Heart failure ENC-00093 · Hospital Medicine |
Clinical judgement required | “heart failure” I50.9 |
clinician judgement | non-CC → — MS-DRG 690 → 690 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 44 | Ines Ashgrove · Chronic kidney disease ENC-00097 · Cardiology |
Clinical judgement required | “CKD stage 3a” N18.31 |
clinician judgement | non-CC → — MS-DRG 291 → 291 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 45 | Rafael Abernath · Hyponatraemia ENC-00099 · Cardiology |
Clinical judgement required | “hyponatremia” E87.1 |
clinician judgement | CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 46 | Wes Hartwell · Acute respiratory failure ENC-00111 · Hospital Medicine |
Clinical judgement required | “acute hypoxic respiratory failure” J96.01 |
clinician judgement | MCC → — MS-DRG 193 → 193 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 47 | Dmitri Jessup · Acute kidney injury ENC-00125 · Cardiology |
Clinical judgement required | “worsening renal function” N28.9 |
clinician judgement | non-CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 48 | Dmitri Jessup · Malnutrition ENC-00125 · Cardiology |
Clinical judgement required | “malnutrition” E46 |
clinician judgement | CC → — MS-DRG 292 → 292 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 49 | Quinn Yardley · Acute respiratory failure ENC-00131 · Cardiology |
Clinical judgement required | “acute hypoxic respiratory failure” J96.01 |
clinician judgement | MCC → — MS-DRG 291 → 291 (RW +0.0000) |
10
|
Open | |||||||||||||||
| 50 | Florian Treadwell · Malnutrition ENC-00134 · Hospital Medicine |
Clinical judgement required | “malnutrition” E46 |
clinician judgement | CC → — MS-DRG 871 → 871 (RW +0.0000) |
10
|
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.