Criteria Library
Organization-defined clinical criteria used by the AI screening engine. Editable by coding leadership without code changes.
| Criteria set | Clinical standard | Target codes | Rules | Version | Updated | Owner | Status |
|---|---|---|---|---|---|---|---|
Severe Malnutrition (Chronic Illness) Six ASPEN characteristics (energy intake, weight loss, fat loss, muscle loss, fluid accumulation, grip strength). Two or more required, with RD assessment and provider concurrence. | ASPEN/AND 2012 | E43E44.0E44.1 | 6 | v1.3 | 07/02/2026 | HIM Coding Leadership | Active |
Sepsis (Sepsis-3) Suspected infection plus SOFA increase of 2 or more, with explicit provider diagnosis carried into inpatient documentation. | Sepsis-3 (2016) | A41.9R65.20R65.21 | 3 | v1.1 | 06/24/2026 | HIM Coding Leadership | Active |
Acute Kidney Injury Creatinine 1.5x baseline within 7 days or 0.3 rise within 48 hours, or urine output criteria, with provider documentation. | KDIGO 2012 | N17.9N17.0 | 3 | v1.2 | 06/24/2026 | HIM Coding Leadership | Active |
Acute Respiratory Failure Hypoxemic or hypercapnic respiratory failure indicators with supporting oxygen or ventilatory requirement and provider documentation. | Clinical indicators (P/F ratio, ABG) | J96.00J96.01J96.02 | 5 | v1.0 | 06/24/2026 | HIM Coding Leadership | Active |
Metabolic Encephalopathy Acute altered mentation with identified metabolic cause, distinguished from dementia baseline, with provider documentation of etiology. | Clinical indicators | G93.41 | 4 | v1.0 | 06/24/2026 | HIM Coding Leadership | Active |
Criteria definitions determine when the engine flags a diagnosis for coder review. All flags require certified coder confirmation and, where noted, provider documentation before any code is finalized.