IP - BE.1.psychoses

CM Codes

Data Overview

20878 total codes in komodo_rii; 302 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	229
CC	69
MCC	4

PCA Analysis

PC1 explains 60.2% of variance; PC1+PC2 together explain 73.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	work rvu	n imaging lines	relative claim charge	n j code lines	icu
1	194.000	8538681.000	3.625	8.860	3.123	0.197	0.046	1.010	0.069	0.013
2	88.000	1554355.000	5.905	10.734	4.357	0.443	0.167	1.210	0.151	0.031
3	20.000	131908.000	9.401	11.887	4.733	0.737	0.489	1.464	0.373	0.100

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	49	12	8	69
MCC	0	1	3	4
No CC/MCC	145	75	9	229
All	194	88	20	302

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_imaging_lines	0.333	-0.237	-0.075
avg_n_distinct_rev_codes	0.322	-0.216	-0.123
rate_or	0.318	-0.232	-0.059
avg_n_j_code_lines	0.317	-0.210	-0.066
rate_transfusion	0.305	-0.107	0.029
rate_icu	0.298	-0.181	-0.089
avg_work_rvu	0.259	-0.269	-0.174
rate_multiple_or_days	0.248	0.190	0.009
avg_relative_claim_charge	0.242	-0.228	-0.008
rate_mechanical_ventilation	0.239	-0.113	0.032
avg_organ_system_count	0.214	-0.182	-0.170
rate_dialysis	0.186	-0.085	0.053
avg_length_of_stay	0.172	-0.200	-0.027
avg_n_distinct_hcps	-0.220	0.097	0.126

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
F445	Conversion disorder with seizures or convulsions	No CC/MCC	10.665	3	12474	icu (+2.90), mechanical ventilation (+2.59), n imaging lines (+1.54)
E8720	Acidosis, unspecified	No CC/MCC	9.730	3	7033	icu (+1.29), mechanical ventilation (+1.21), n j code lines (+1.18)
E875	Hyperkalemia	No CC/MCC	7.093	3	4717	dialysis (+2.10), transfusion (+1.21), n j code lines (+0.96)
E8342	Hypomagnesemia	No CC/MCC	7.056	3	5462	transfusion (+0.97), n j code lines (+0.93), icu (+0.81)
I480	Paroxysmal atrial fibrillation	No CC/MCC	6.468	3	5534	n imaging lines (+0.79), n distinct rev codes (+0.78), transfusion (+0.77)

Under-tiered: Tier 1, MCC (0 codes)

None.

Top Codes by Tier

Tier 1 (n=194 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E063	Autoimmune thyroiditis	No CC/MCC	-0.109	3695	relative claim charge (-0.13), multiple or days (-0.11), n distinct hcps (+0.11)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-0.113	122494	organ system count (+0.12), n distinct hcps (+0.09), or (-0.09)
B353	Tinea pedis	No CC/MCC	-0.230	4974	relative claim charge (+0.26), length of stay (+0.26), work rvu (+0.21)
B182	Chronic viral hepatitis C	No CC/MCC	-0.274	8301	organ system count (+0.15), relative claim charge (-0.09), n imaging lines (-0.09)
F1011	Alcohol abuse, in remission	No CC/MCC	-0.313	8372	n distinct hcps (+0.20), transfusion (-0.13), multiple or days (-0.11)
S51812A	Laceration without foreign body of left forearm, initial encounter	No CC/MCC	-0.324	5235	multiple or days (+0.46), length of stay (-0.18), relative claim charge (-0.17)
G809	Cerebral palsy, unspecified	No CC/MCC	-0.341	3343	n distinct hcps (+0.16), n j code lines (-0.13), multiple or days (-0.11)
G8929	Other chronic pain	No CC/MCC	-0.362	90338	organ system count (+0.25), transfusion (-0.08), relative claim charge (-0.08)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	-0.396	31383	organ system count (+0.32), n j code lines (-0.16), work rvu (-0.11)
M25511	Pain in right shoulder	No CC/MCC	-0.404	4717	work rvu (+0.22), transfusion (-0.17), organ system count (+0.17)

Tier 2 (n=88 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	4.714	5597	transfusion (+0.84), n distinct rev codes (+0.68), n imaging lines (+0.58)
I951	Orthostatic hypotension	No CC/MCC	4.656	3287	n imaging lines (+0.65), work rvu (+0.65), n distinct rev codes (+0.61)
F0394	Unspecified dementia, unspecified severity, with anxiety	No CC/MCC	3.879	3898	work rvu (+1.74), n distinct rev codes (+0.65), relative claim charge (+0.42)
M6282	Rhabdomyolysis	CC	3.860	6783	n j code lines (+0.81), icu (+0.78), mechanical ventilation (+0.55)
E871	Hypo-osmolality and hyponatremia	CC	3.770	25117	n distinct rev codes (+0.40), work rvu (+0.40), transfusion (+0.37)
F0393	Unspecified dementia, unspecified severity, with mood disturbance	No CC/MCC	3.682	4898	work rvu (+1.35), n distinct rev codes (+0.59), n distinct hcps (+0.41)
F03918	Unspecified dementia, unspecified severity, with other behavioral disturbance	No CC/MCC	3.181	5930	work rvu (+1.34), relative claim charge (+0.48), length of stay (+0.41)
I959	Hypotension, unspecified	No CC/MCC	3.147	13575	multiple or days (+0.65), n j code lines (+0.30), mechanical ventilation (+0.27)
M810	Age-related osteoporosis without current pathological fracture	No CC/MCC	3.053	5558	organ system count (+0.43), or (+0.42), multiple or days (+0.39)
J439	Emphysema, unspecified	No CC/MCC	3.011	4138	n j code lines (+0.51), n distinct rev codes (+0.40), n imaging lines (+0.37)

Tier 3 (n=20 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G9341	Metabolic encephalopathy	MCC	19.064	3494	multiple or days (+2.39), transfusion (+2.37), n imaging lines (+2.25)
G9340	Encephalopathy, unspecified	CC	14.276	4683	n imaging lines (+2.22), or (+2.12), mechanical ventilation (+1.87)
F05	Delirium due to known physiological condition	CC	13.084	5170	or (+2.46), transfusion (+1.81), n imaging lines (+1.80)
F445	Conversion disorder with seizures or convulsions	No CC/MCC	10.665	12474	icu (+2.90), mechanical ventilation (+2.59), n imaging lines (+1.54)
E43	Unspecified severe protein-calorie malnutrition	MCC	10.411	5602	or (+1.34), transfusion (+1.33), n j code lines (+1.11)
E8720	Acidosis, unspecified	No CC/MCC	9.730	7033	icu (+1.29), mechanical ventilation (+1.21), n j code lines (+1.18)
F202	Catatonic schizophrenia	CC	8.535	4245	multiple or days (+1.45), or (+1.23), relative claim charge (+1.19)
I5032	Chronic diastolic (congestive) heart failure	CC	8.148	5282	dialysis (+1.17), n distinct rev codes (+0.97), transfusion (+0.90)
N179	Acute kidney failure, unspecified	CC	7.940	19064	n j code lines (+1.09), transfusion (+1.05), multiple or days (+0.99)
E870	Hyperosmolality and hypernatremia	CC	7.783	4355	or (+0.95), mechanical ventilation (+0.83), transfusion (+0.79)

Key Driver Frequency

feature	count	pct
n distinct rev codes	150	49.700
organ system count	139	46.000
relative claim charge	111	36.800
n j code lines	110	36.400
n distinct hcps	92	30.500
n imaging lines	73	24.200
transfusion	52	17.200
work rvu	49	16.200
length of stay	39	12.900
multiple or days	34	11.300
or	28	9.300
icu	13	4.300
mechanical ventilation	9	3.000
dialysis	7	2.300

PCS Codes

Data Overview

1755 total codes in komodo_rii; 15 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 63.7% of variance; PC1+PC2 together explain 88.7%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	work rvu	relative claim charge	organ system count	n imaging lines	n j code lines	icu
1	6.000	155226.000	8.712	1.833	0.036	0.990	2.804	0.006	0.010	0.002
2	6.000	147987.000	10.579	6.176	0.138	1.034	2.871	0.080	0.225	0.008
3	2.000	10495.000	21.018	8.164	2.253	2.676	3.738	0.176	0.220	0.039
4	1.000	4686.000	5.700	11.056	0.695	1.141	3.694	0.740	0.485	0.226

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
rate_or	0.322	-0.386
rate_transfusion	0.317	-0.252
avg_n_imaging_lines	0.316	-0.461
rate_icu	0.304	-0.136
rate_multiple_or_days	0.295	-0.280
avg_organ_system_count	0.294	-0.443
avg_n_distinct_rev_codes	0.288	-0.396
avg_n_j_code_lines	0.284	-0.282
rate_mechanical_ventilation	0.278	-0.188
rate_dialysis	0.272	-0.323
avg_work_rvu	0.206	-0.375
avg_relative_claim_charge	0.170	-0.696
avg_length_of_stay	0.093	-0.182
avg_n_distinct_hcps	-0.190	0.132

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=6 codes)

code	Description	Score	N claims	Key drivers
HZ90ZZZ	PHARMACOTHERAPY FOR SUBSTANCE ABUSE TREATMENT, NICOTINE REPLACEMENT	-1.967	5559	n j code lines (-0.29), n distinct rev codes (-0.20), organ system count (-0.18)
HZ2ZZZZ	DETOXIFICATION SERVICES FOR SUBSTANCE ABUSE TREATMENT	-2.010	108521	n distinct rev codes (-0.30), n j code lines (-0.27), organ system count (-0.18)
HZ80ZZZ	MEDICATION MANAGEMENT FOR SUBSTANCE ABUSE TREATMENT, NICOTINE REPLACEMENT	-2.214	15500	n distinct rev codes (-0.32), n j code lines (-0.32), n distinct hcps (-0.20)
HZ89ZZZ	MEDICATION MANAGEMENT FOR SUBSTANCE ABUSE TREATMENT, OTHER REPLACEMENT MEDICATION	-2.255	11406	n distinct rev codes (-0.34), n j code lines (-0.31), organ system count (-0.22)
HZ84ZZZ	MEDICATION MANAGEMENT FOR SUBSTANCE ABUSE TREATMENT, NALTREXONE	-2.280	7879	n distinct rev codes (-0.34), n j code lines (-0.32), transfusion (-0.19)
HZ99ZZZ	PHARMACOTHERAPY FOR SUBSTANCE ABUSE TREATMENT, OTHER REPLACEMENT MEDICATION	-2.344	6361	n distinct rev codes (-0.35), n j code lines (-0.32), n distinct hcps (-0.24)

Tier 2 (n=6 codes)

code	Description	Score	N claims	Key drivers
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	0.118	4159	n distinct hcps (+0.33), transfusion (+0.17), multiple or days (-0.13)
GZHZZZZ	GROUP PSYCHOTHERAPY	-0.011	74955	n distinct hcps (+0.34), n j code lines (+0.22), n distinct rev codes (+0.14)
GZ51ZZZ	INDIVIDUAL PSYCHOTHERAPY, BEHAVIORAL	-0.245	6463	n j code lines (+0.22), n distinct rev codes (+0.20), transfusion (-0.15)
GZ58ZZZ	INDIVIDUAL PSYCHOTHERAPY, COGNITIVE-BEHAVIORAL	-0.565	3337	transfusion (-0.19), n distinct rev codes (+0.18), organ system count (-0.18)
GZ3ZZZZ	MEDICATION MANAGEMENT	-0.816	37012	organ system count (-0.20), or (-0.15), multiple or days (-0.13)
GZ56ZZZ	INDIVIDUAL PSYCHOTHERAPY, SUPPORTIVE	-0.823	22061	organ system count (-0.17), or (-0.14), multiple or days (-0.13)

Tier 3 (n=2 codes)

code	Description	Score	N claims	Key drivers
GZB2ZZZ	ELECTROCONVULSIVE THERAPY, BILATERAL-SINGLE SEIZURE	4.649	5165	multiple or days (+0.84), organ system count (+0.67), or (+0.66)
GZB0ZZZ	ELECTROCONVULSIVE THERAPY, UNILATERAL-SINGLE SEIZURE	1.925	5330	work rvu (+0.50), organ system count (+0.49), relative claim charge (+0.35)

Tier 4 (n=1 codes)

code	Description	Score	N claims	Key drivers
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	8.839	4686	n imaging lines (+1.12), icu (+1.10), transfusion (+1.06)

Key Driver Frequency

feature	count	pct
n distinct rev codes	9	60.000
n j code lines	8	53.300
organ system count	8	53.300
transfusion	5	33.300
n distinct hcps	4	26.700
multiple or days	4	26.700
or	3	20.000
work rvu	1	6.700
relative claim charge	1	6.700
n imaging lines	1	6.700
icu	1	6.700