IP - CA.1.heart_attack

CM Codes

Data Overview

12471 total codes in komodo_rii; 425 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	277
CC	106
MCC	42

PCA Analysis

PC1 explains 46.8% of variance; PC1+PC2 together explain 60.3%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	n imaging lines	organ system count	work rvu	n j code lines	icu
1	293.000	3207008.000	15.836	4.944	1.012	0.644	5.189	0.553	0.352	0.434
2	116.000	645693.000	17.892	7.107	1.280	0.835	5.636	0.693	0.452	0.491
3	16.000	54859.000	21.275	10.161	2.076	1.342	5.855	1.132	0.698	0.653

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	57	43	6	106
MCC	19	14	9	42
No CC/MCC	217	59	1	277
All	293	116	16	425

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.369	-0.083	0.284
avg_relative_claim_charge	0.364	0.015	0.380
rate_or	0.346	0.007	0.347
avg_length_of_stay	0.335	-0.056	0.270
rate_icu	0.284	0.085	0.341
rate_multiple_or_days	0.284	0.099	0.307
avg_n_imaging_lines	0.283	-0.259	0.156
rate_transfusion	0.275	0.033	0.295
rate_mechanical_ventilation	0.264	0.094	0.460
avg_n_j_code_lines	0.179	-0.033	0.283
avg_work_rvu	0.157	-0.021	0.302
rate_dialysis	0.154	0.084	0.245
avg_organ_system_count	0.151	-0.233	-0.261
avg_n_distinct_hcps	-0.097	-0.201	-0.414

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (1 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G928	Other toxic encephalopathy	No CC/MCC	7.297	3	4462	n distinct rev codes (+1.10), relative claim charge (+1.10), n imaging lines (+1.06)

Under-tiered: Tier 1, MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I222	Subsequent non-ST elevation (NSTEMI) myocardial infarction	MCC	-2.539	1	1053	n distinct rev codes (-0.50), relative claim charge (-0.44), n imaging lines (-0.30)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	-2.174	1	223599	length of stay (-0.35), n distinct rev codes (-0.34), organ system count (-0.25)
I2542	Coronary artery dissection	MCC	-2.121	1	3106	length of stay (-0.56), organ system count (-0.46), n distinct rev codes (-0.42)
I21A9	Other myocardial infarction type	MCC	-1.514	1	1477	n imaging lines (-0.47), length of stay (-0.36), multiple or days (+0.28)
I2119	ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall	MCC	-1.344	1	8940	icu (+0.75), n imaging lines (-0.45), length of stay (-0.43)

Top Codes by Tier

Tier 1 (n=293 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K2100	Gastro-esophageal reflux disease with esophagitis, without bleeding	No CC/MCC	0.333	1283	multiple or days (+0.35), organ system count (+0.13), n distinct rev codes (+0.13)
D6859	Other primary thrombophilia	CC	0.318	1016	multiple or days (-0.25), work rvu (-0.17), or (+0.16)
T451X5A	Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter	No CC/MCC	0.318	914	transfusion (+0.56), organ system count (+0.26), n j code lines (-0.19)
I959	Hypotension, unspecified	No CC/MCC	0.289	18954	icu (+0.20), n distinct rev codes (+0.08), organ system count (-0.07)
C9000	Multiple myeloma not having achieved remission	CC	0.256	1223	transfusion (+0.42), icu (-0.26), multiple or days (+0.20)
E1121	Type 2 diabetes mellitus with diabetic nephropathy	No CC/MCC	0.237	1245	multiple or days (-0.25), n imaging lines (-0.17), length of stay (+0.15)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	0.232	3783	transfusion (+0.30), organ system count (+0.14), n distinct rev codes (+0.14)
D539	Nutritional anemia, unspecified	No CC/MCC	0.224	3821	transfusion (+0.30), organ system count (+0.17), n j code lines (-0.15)
K861	Other chronic pancreatitis	CC	0.207	978	multiple or days (+0.54), icu (-0.18), relative claim charge (-0.17)
C7951	Secondary malignant neoplasm of bone	CC	0.199	1813	n imaging lines (+0.32), transfusion (+0.28), icu (-0.19)

Tier 2 (n=116 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G9341	Metabolic encephalopathy	MCC	5.487	13356	n distinct rev codes (+0.89), n imaging lines (+0.84), length of stay (+0.69)
K922	Gastrointestinal hemorrhage, unspecified	CC	5.220	1833	transfusion (+1.87), multiple or days (+0.94), n distinct rev codes (+0.49)
G9340	Encephalopathy, unspecified	CC	5.163	4047	n imaging lines (+0.88), n distinct rev codes (+0.84), length of stay (+0.56)
D6832	Hemorrhagic disorder due to extrinsic circulating anticoagulants	CC	4.951	787	transfusion (+1.20), relative claim charge (+0.70), length of stay (+0.68)
J918	Pleural effusion in other conditions classified elsewhere	CC	4.919	4283	or (+2.40), n distinct rev codes (+0.82), length of stay (+0.51)
D689	Coagulation defect, unspecified	CC	4.892	2063	or (+0.75), relative claim charge (+0.74), n distinct rev codes (+0.62)
E870	Hyperosmolality and hypernatremia	CC	4.785	4620	relative claim charge (+0.89), length of stay (+0.86), n distinct rev codes (+0.83)
B952	Enterococcus as the cause of diseases classified elsewhere	No CC/MCC	4.713	813	multiple or days (+1.06), length of stay (+0.95), n distinct rev codes (+0.72)
E1152	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene	CC	4.548	821	or (+0.96), length of stay (+0.85), relative claim charge (+0.78)
A0472	Enterocolitis due to Clostridium difficile, not specified as recurrent	CC	4.531	951	length of stay (+0.94), relative claim charge (+0.81), multiple or days (+0.57)

Tier 3 (n=16 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G931	Anoxic brain damage, not elsewhere classified	CC	13.788	1144	mechanical ventilation (+2.95), relative claim charge (+2.27), n imaging lines (+1.48)
T80211A	Bloodstream infection due to central venous catheter, initial encounter	CC	13.109	1140	or (+3.08), relative claim charge (+1.66), n distinct rev codes (+1.45)
I469	Cardiac arrest, cause unspecified	MCC	12.377	2831	mechanical ventilation (+2.75), relative claim charge (+1.76), icu (+1.44)
K7200	Acute and subacute hepatic failure without coma	MCC	10.371	3044	relative claim charge (+1.67), n distinct rev codes (+1.26), icu (+1.24)
K567	Ileus, unspecified	CC	9.713	766	relative claim charge (+1.57), length of stay (+1.30), n distinct rev codes (+1.16)
D62	Acute posthemorrhagic anemia	CC	9.491	8206	transfusion (+2.34), or (+1.29), relative claim charge (+1.28)
I462	Cardiac arrest due to underlying cardiac condition	MCC	9.452	2492	mechanical ventilation (+2.04), relative claim charge (+1.59), icu (+1.29)
I330	Acute and subacute infective endocarditis	MCC	9.192	1452	multiple or days (+1.94), or (+1.37), relative claim charge (+1.13)
A419	Sepsis, unspecified organism	MCC	8.275	6107	relative claim charge (+1.11), n distinct rev codes (+1.08), length of stay (+0.86)
J690	Pneumonitis due to inhalation of food and vomit	MCC	8.207	5389	relative claim charge (+1.36), n distinct rev codes (+1.18), mechanical ventilation (+1.09)

Key Driver Frequency

feature	count	pct
n distinct rev codes	235	55.300
length of stay	184	43.300
relative claim charge	171	40.200
icu	118	27.800
n imaging lines	111	26.100
multiple or days	111	26.100
or	111	26.100
organ system count	71	16.700
transfusion	53	12.500
n j code lines	35	8.200
work rvu	26	6.100
dialysis	21	4.900
n distinct hcps	20	4.700
mechanical ventilation	8	1.900

PCS Codes

Data Overview

2477 total codes in komodo_rii; 62 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 59.7% of variance; PC1+PC2 together explain 73.4%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	organ system count	work rvu	n imaging lines	mechanical ventilation	or
1	25.000	375827.000	4.290	16.326	1.161	4.277	0.375	0.540	0.017	0.067
2	13.000	75166.000	7.135	18.173	1.501	4.859	0.549	0.763	0.041	0.152
3	11.000	29841.000	8.478	21.018	1.787	5.259	0.609	0.990	0.200	0.402
4	12.000	31087.000	10.941	22.967	2.372	5.528	0.887	1.122	0.321	0.483
5	1.000	1314.000	17.000	25.449	4.200	5.877	1.760	1.921	1.000	0.499

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.330	-0.260
avg_length_of_stay	0.329	-0.357
avg_relative_claim_charge	0.325	-0.233
avg_organ_system_count	0.322	-0.372
avg_n_imaging_lines	0.320	-0.292
rate_or	0.280	-0.282
rate_multiple_or_days	0.273	-0.142
avg_work_rvu	0.268	-0.253
rate_icu	0.265	-0.084
rate_mechanical_ventilation	0.226	-0.089
rate_transfusion	0.225	-0.378
avg_n_j_code_lines	0.218	-0.358
rate_dialysis	0.159	-0.242
avg_n_distinct_hcps	-0.049	0.012

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=25 codes)

code	Description	Score	N claims	Key drivers
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-1.738	1512	n distinct rev codes (-0.29), relative claim charge (-0.28), icu (-0.27)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	-2.145	8707	organ system count (-0.38), n imaging lines (-0.26), n distinct rev codes (-0.23)
8E0ZXY6	ISOLATION	-2.174	2713	n distinct rev codes (-0.43), work rvu (-0.33), relative claim charge (-0.27)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-2.207	2736	n distinct rev codes (-0.54), relative claim charge (-0.33), organ system count (-0.32)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-2.278	6149	n distinct rev codes (-0.39), relative claim charge (-0.33), length of stay (-0.26)
B213YZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERY BYPASS GRAFTS USING OTHER CONTRAST	-2.301	1019	n imaging lines (-0.41), length of stay (-0.31), organ system count (-0.29)
B218YZZ	FLUOROSCOPY OF LEFT INTERNAL MAMMARY BYPASS GRAFT USING OTHER CONTRAST	-2.316	797	n imaging lines (-0.36), length of stay (-0.32), organ system count (-0.27)
B41F1ZZ	FLUOROSCOPY OF RIGHT LOWER EXTREMITY ARTERIES USING LOW OSMOLAR CONTRAST	-2.432	2561	length of stay (-0.30), organ system count (-0.28), work rvu (-0.28)
B241ZZ3	ULTRASONOGRAPHY OF MULTIPLE CORONARY ARTERIES, INTRAVASCULAR	-2.451	1770	n imaging lines (-0.40), length of stay (-0.36), organ system count (-0.32)
B2161ZZ	FLUOROSCOPY OF RIGHT AND LEFT HEART USING LOW OSMOLAR CONTRAST	-2.466	1513	organ system count (-0.31), length of stay (-0.27), multiple or days (-0.24)

Tier 2 (n=13 codes)

code	Description	Score	N claims	Key drivers
5A0945A	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	0.509	1164	icu (+0.37), length of stay (+0.24), multiple or days (-0.24)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	0.434	2511	icu (+0.30), multiple or days (-0.15), n j code lines (+0.12)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	0.038	20640	dialysis (+0.63), organ system count (+0.25), n j code lines (-0.17)
4A023N6	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, RIGHT HEART, PERCUTANEOUS APPROACH	-0.081	4967	length of stay (+0.18), relative claim charge (+0.09), or (-0.09)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.152	2911	icu (+0.19), organ system count (+0.15), or (-0.14)
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	-0.301	1179	n j code lines (+0.46), work rvu (+0.26), n distinct rev codes (-0.25)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-0.750	1235	n distinct rev codes (-0.27), n j code lines (-0.23), multiple or days (-0.15)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	-0.944	2054	n j code lines (+0.47), relative claim charge (-0.31), work rvu (+0.28)
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	-0.968	1889	organ system count (-0.19), relative claim charge (-0.12), multiple or days (-0.12)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.111	20056	n imaging lines (-0.18), or (-0.16), multiple or days (-0.15)

Tier 3 (n=11 codes)

code	Description	Score	N claims	Key drivers
5A12012	PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL	2.763	1477	n imaging lines (+0.55), icu (+0.48), mechanical ventilation (+0.45)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.188	2085	transfusion (+0.48), organ system count (+0.39), multiple or days (+0.35)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	2.155	2108	mechanical ventilation (+0.79), icu (+0.49), n imaging lines (+0.34)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.080	2568	icu (+0.48), n imaging lines (+0.32), n j code lines (+0.27)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.926	1937	multiple or days (+0.61), n distinct rev codes (+0.39), transfusion (+0.37)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	1.889	1350	multiple or days (+0.46), n j code lines (+0.33), or (+0.26)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.765	978	multiple or days (+0.61), organ system count (+0.39), n distinct rev codes (+0.38)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.708	9350	transfusion (+0.95), organ system count (+0.34), length of stay (+0.14)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	1.172	4218	or (+0.54), n distinct rev codes (+0.23), n imaging lines (+0.22)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	1.034	1032	or (+0.64), multiple or days (+0.22), organ system count (+0.20)

Tier 4 (n=12 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.788	4941	mechanical ventilation (+0.71), n imaging lines (+0.70), icu (+0.57)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	4.575	1810	or (+0.72), length of stay (+0.64), n distinct rev codes (+0.59)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	4.535	3224	mechanical ventilation (+0.79), n imaging lines (+0.65), icu (+0.59)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	4.253	2491	work rvu (+0.53), icu (+0.50), n imaging lines (+0.47)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	4.197	3155	or (+0.80), length of stay (+0.66), n distinct rev codes (+0.63)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	4.137	899	work rvu (+0.49), icu (+0.46), relative claim charge (+0.46)
0W3P8ZZ	CONTROL BLEEDING IN GASTROINTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.747	765	transfusion (+0.70), multiple or days (+0.66), work rvu (+0.56)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	3.741	1517	n j code lines (+0.64), icu (+0.55), work rvu (+0.54)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.707	9113	or (+0.48), length of stay (+0.44), n distinct rev codes (+0.44)
05HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	3.505	948	length of stay (+0.51), n distinct rev codes (+0.46), relative claim charge (+0.44)

Tier 5 (n=1 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	9.034	1314	relative claim charge (+1.43), n imaging lines (+1.20), length of stay (+1.09)

Key Driver Frequency

feature	count	pct
length of stay	28	45.200
organ system count	26	41.900
n distinct rev codes	25	40.300
n imaging lines	20	32.300
multiple or days	14	22.600
icu	14	22.600
relative claim charge	14	22.600
or	12	19.400
work rvu	11	17.700
n j code lines	11	17.700
transfusion	5	8.100
mechanical ventilation	4	6.500
dialysis	2	3.200