IP - CA.1.intraluminal_device

CM Codes

Data Overview

7724 total codes in komodo_rii; 241 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	151
CC	53
MCC	37

PCA Analysis

PC1 explains 52.8% of variance; PC1+PC2 together explain 63.2%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	n imaging lines	work rvu	n j code lines	mechanical ventilation
1	167.000	977416.000	16.102	3.455	4.295	1.015	0.368	0.567	0.421	0.015
2	59.000	175964.000	18.828	5.684	4.601	1.247	0.591	0.686	0.504	0.053
3	15.000	18642.000	22.793	8.780	5.006	1.700	1.046	0.966	0.680	0.246

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	29	21	3	53
MCC	10	16	11	37
No CC/MCC	128	22	1	151
All	167	59	15	241

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.356	-0.193	0.482
avg_relative_claim_charge	0.352	-0.167	0.490
rate_or	0.351	-0.153	0.515
avg_length_of_stay	0.344	-0.182	0.400
avg_n_imaging_lines	0.332	-0.289	0.323
rate_transfusion	0.299	-0.140	0.472
rate_mechanical_ventilation	0.296	0.015	0.523
rate_icu	0.263	-0.062	0.445
avg_n_j_code_lines	0.228	-0.052	0.355
avg_work_rvu	0.198	-0.145	0.328
rate_dialysis	0.151	-0.114	0.429
avg_organ_system_count	0.143	-0.257	-0.141
rate_multiple_or_days	0.130	0.090	0.087
avg_n_distinct_hcps	0.005	-0.168	-0.234

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	8.370	3	765	n imaging lines (+1.58), relative claim charge (+1.22), n distinct rev codes (+1.21)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	-1.765	1	74134	relative claim charge (-0.23), icu (-0.22), or (-0.21)
I21A9	Other myocardial infarction type	MCC	-1.685	1	2140	n imaging lines (-0.29), length of stay (-0.26), n distinct rev codes (-0.22)
I2119	ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall	MCC	-1.492	1	18222	icu (+0.52), n imaging lines (-0.42), length of stay (-0.34)
I2129	ST elevation (STEMI) myocardial infarction involving other sites	MCC	-1.320	1	2191	icu (+0.48), n imaging lines (-0.38), length of stay (-0.30)
I2121	ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery	MCC	-1.193	1	1850	icu (+0.47), n imaging lines (-0.35), length of stay (-0.30)

Top Codes by Tier

Tier 1 (n=167 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I080	Rheumatic disorders of both mitral and aortic valves	No CC/MCC	0.232	1265	work rvu (+0.43), multiple or days (+0.26), icu (-0.18)
E860	Dehydration	No CC/MCC	0.126	1440	n imaging lines (+0.32), work rvu (-0.23), or (-0.17)
K7460	Unspecified cirrhosis of liver	No CC/MCC	0.029	678	organ system count (+0.23), n imaging lines (+0.16), n j code lines (-0.12)
F1410	Cocaine abuse, uncomplicated	No CC/MCC	0.007	600	n j code lines (+0.67), relative claim charge (-0.22), length of stay (-0.19)
E11319	Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema	No CC/MCC	-0.012	666	n j code lines (+0.21), multiple or days (+0.21), icu (-0.19)
I959	Hypotension, unspecified	No CC/MCC	-0.017	5840	icu (+0.27), work rvu (+0.10), organ system count (-0.10)
J9611	Chronic respiratory failure with hypoxia	CC	-0.082	1446	icu (-0.24), mechanical ventilation (-0.15), transfusion (+0.11)
I420	Dilated cardiomyopathy	CC	-0.088	1468	work rvu (+0.20), n j code lines (+0.20), icu (-0.14)
F1510	Other stimulant abuse, uncomplicated	No CC/MCC	-0.122	539	n j code lines (+0.42), icu (+0.32), multiple or days (+0.29)
G894	Chronic pain syndrome	No CC/MCC	-0.148	762	multiple or days (+0.44), organ system count (+0.30), length of stay (-0.18)

Tier 2 (n=59 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1110	Type 2 diabetes mellitus with ketoacidosis without coma	MCC	4.871	626	n j code lines (+0.77), icu (+0.70), n distinct rev codes (+0.57)
I462	Cardiac arrest due to underlying cardiac condition	MCC	4.848	2621	mechanical ventilation (+1.26), icu (+0.74), or (+0.67)
F05	Delirium due to known physiological condition	CC	4.523	886	n imaging lines (+0.76), length of stay (+0.74), n distinct rev codes (+0.66)
J9601	Acute respiratory failure with hypoxia	MCC	4.436	11929	n distinct rev codes (+0.70), or (+0.60), relative claim charge (+0.59)
E873	Alkalosis	CC	4.122	514	relative claim charge (+1.03), length of stay (+0.87), n distinct rev codes (+0.75)
E8729	Other acidosis	No CC/MCC	4.083	544	n distinct rev codes (+0.75), mechanical ventilation (+0.65), n imaging lines (+0.59)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	4.014	3588	dialysis (+1.13), or (+0.72), transfusion (+0.67)
N186	End stage renal disease	MCC	3.980	4950	dialysis (+1.16), transfusion (+0.66), or (+0.64)
E440	Moderate protein-calorie malnutrition	CC	3.849	1089	length of stay (+0.68), n distinct rev codes (+0.52), n j code lines (+0.45)
J189	Pneumonia, unspecified organism	MCC	3.767	4072	n distinct rev codes (+0.65), n imaging lines (+0.56), length of stay (+0.52)

Tier 3 (n=15 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K7200	Acute and subacute hepatic failure without coma	MCC	11.314	993	or (+1.59), mechanical ventilation (+1.38), relative claim charge (+1.26)
J690	Pneumonitis due to inhalation of food and vomit	MCC	10.416	1520	mechanical ventilation (+1.63), relative claim charge (+1.42), n imaging lines (+1.36)
A419	Sepsis, unspecified organism	MCC	10.081	1181	relative claim charge (+1.39), or (+1.23), n distinct rev codes (+1.19)
N170	Acute kidney failure with tubular necrosis	MCC	9.167	1726	relative claim charge (+1.33), or (+1.18), length of stay (+1.15)
D62	Acute posthemorrhagic anemia	CC	8.850	2299	transfusion (+2.84), or (+1.44), relative claim charge (+0.83)
G9341	Metabolic encephalopathy	MCC	8.783	1953	n imaging lines (+1.48), n distinct rev codes (+1.16), relative claim charge (+1.15)
G928	Other toxic encephalopathy	No CC/MCC	8.370	765	n imaging lines (+1.58), relative claim charge (+1.22), n distinct rev codes (+1.21)
J9602	Acute respiratory failure with hypercapnia	MCC	7.708	1134	mechanical ventilation (+1.28), n distinct rev codes (+0.98), relative claim charge (+0.95)
I469	Cardiac arrest, cause unspecified	MCC	7.405	1289	mechanical ventilation (+1.72), n imaging lines (+0.99), n distinct rev codes (+0.90)
G9340	Encephalopathy, unspecified	CC	7.363	744	n imaging lines (+1.37), mechanical ventilation (+0.96), n distinct rev codes (+0.96)

Key Driver Frequency

feature	count	pct
n distinct rev codes	110	45.600
length of stay	104	43.200
relative claim charge	91	37.800
icu	83	34.400
or	83	34.400
n imaging lines	64	26.600
n j code lines	57	23.700
work rvu	41	17.000
organ system count	35	14.500
transfusion	22	9.100
multiple or days	15	6.200
mechanical ventilation	13	5.400
dialysis	5	2.100

PCS Codes

Data Overview

2472 total codes in komodo_rii; 60 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 57.5% of variance; PC1+PC2 together explain 74.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	n imaging lines	mechanical ventilation	work rvu	transfusion
1	43.000	577315.000	16.585	3.640	3.823	1.104	0.368	0.021	0.487	0.035
2	10.000	20670.000	20.055	5.966	4.364	1.356	0.614	0.198	0.789	0.093
3	7.000	9221.000	24.240	9.244	5.011	1.822	1.024	0.433	0.772	0.344

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.346	-0.273
avg_length_of_stay	0.338	-0.370
avg_n_imaging_lines	0.338	-0.174
rate_or	0.334	-0.427
avg_organ_system_count	0.331	-0.230
avg_relative_claim_charge	0.318	-0.323
rate_icu	0.262	-0.126
rate_transfusion	0.242	-0.317
rate_mechanical_ventilation	0.241	-0.197
avg_n_j_code_lines	0.198	-0.179
avg_work_rvu	0.195	-0.145
avg_n_distinct_hcps	0.168	-0.147
rate_dialysis	0.149	-0.280
rate_multiple_or_days	0.127	0.058

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=43 codes)

code	Description	Score	N claims	Key drivers
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	0.081	2706	icu (+0.21), organ system count (-0.17), n distinct rev codes (+0.11)
02C03Z7	EXTIRPATION OF MATTER FROM CORONARY ARTERY, ONE ARTERY, ORBITAL ATHERECTOMY TECHNIQUE, PERCUTANEOUS APPROACH	0.042	556	icu (-0.28), work rvu (+0.27), n j code lines (+0.26)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-0.622	2447	work rvu (+0.37), n distinct hcps (-0.37), n j code lines (+0.36)
02713ZZ	DILATION OF CORONARY ARTERY, TWO ARTERIES, PERCUTANEOUS APPROACH	-0.946	609	n imaging lines (-0.21), n distinct rev codes (-0.20), relative claim charge (+0.17)
B2101ZZ	FLUOROSCOPY OF SINGLE CORONARY ARTERY USING LOW OSMOLAR CONTRAST	-0.979	2619	or (-0.18), n distinct rev codes (-0.17), n imaging lines (-0.17)
02C03ZZ	EXTIRPATION OF MATTER FROM CORONARY ARTERY, ONE ARTERY, PERCUTANEOUS APPROACH	-1.162	10682	n imaging lines (-0.25), organ system count (-0.23), length of stay (-0.20)
027236Z	DILATION OF CORONARY ARTERY, THREE ARTERIES WITH THREE DRUG-ELUTING INTRALUMINAL DEVICES, PERCUTANEOUS APPROACH	-1.173	1574	n distinct hcps (-0.18), relative claim charge (+0.18), n distinct rev codes (-0.17)
02703ZZ	DILATION OF CORONARY ARTERY, ONE ARTERY, PERCUTANEOUS APPROACH	-1.176	7053	or (-0.18), n imaging lines (-0.17), n distinct rev codes (-0.16)
027237Z	DILATION OF CORONARY ARTERY, THREE ARTERIES WITH FOUR OR MORE DRUG-ELUTING INTRALUMINAL DEVICES, PERCUTANEOUS APPROACH	-1.188	950	relative claim charge (+0.35), n distinct hcps (-0.25), organ system count (-0.20)
3E073PZ	INTRODUCTION OF PLATELET INHIBITOR INTO CORONARY ARTERY, PERCUTANEOUS APPROACH	-1.189	523	organ system count (-0.36), n distinct hcps (+0.33), n imaging lines (-0.29)

Tier 2 (n=10 codes)

code	Description	Score	N claims	Key drivers
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	3.781	1186	mechanical ventilation (+1.01), icu (+0.57), n distinct rev codes (+0.50)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	3.302	3443	dialysis (+1.06), organ system count (+0.62), length of stay (+0.39)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.051	1172	icu (+0.58), n distinct rev codes (+0.37), n imaging lines (+0.34)
5A12012	PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL	2.815	1231	icu (+0.49), n distinct rev codes (+0.39), n imaging lines (+0.36)
4A023N6	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, RIGHT HEART, PERCUTANEOUS APPROACH	2.475	1594	length of stay (+0.53), organ system count (+0.29), n imaging lines (+0.28)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	2.001	1084	n j code lines (+0.82), work rvu (+0.81), multiple or days (+0.72)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.552	3286	organ system count (+0.48), n distinct rev codes (+0.25), length of stay (+0.23)
5A1223Z	PERFORMANCE OF CARDIAC PACING, CONTINUOUS	1.351	1051	or (+0.57), icu (+0.37), n distinct hcps (+0.24)
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	0.729	829	length of stay (+0.28), n imaging lines (+0.28), n distinct rev codes (+0.23)
4A023N8	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, BILATERAL, PERCUTANEOUS APPROACH	0.375	5794	length of stay (+0.17), n j code lines (+0.15), n distinct hcps (-0.15)

Tier 3 (n=7 codes)

code	Description	Score	N claims	Key drivers
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	8.076	817	n imaging lines (+0.97), length of stay (+0.88), n j code lines (+0.87)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	8.029	1913	or (+1.23), length of stay (+1.08), n distinct rev codes (+0.94)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	6.835	1285	n imaging lines (+1.04), mechanical ventilation (+1.01), n distinct rev codes (+0.98)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	6.176	1661	transfusion (+1.52), organ system count (+0.82), length of stay (+0.75)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	6.097	2442	mechanical ventilation (+0.85), n imaging lines (+0.84), n distinct rev codes (+0.82)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	5.978	531	organ system count (+0.92), length of stay (+0.88), transfusion (+0.78)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	4.562	572	icu (+0.65), n imaging lines (+0.65), relative claim charge (+0.65)

Key Driver Frequency

feature	count	pct
n distinct rev codes	31	51.700
length of stay	26	43.300
relative claim charge	25	41.700
organ system count	21	35.000
n imaging lines	18	30.000
or	16	26.700
icu	15	25.000
n distinct hcps	9	15.000
n j code lines	6	10.000
work rvu	6	10.000
mechanical ventilation	3	5.000
transfusion	2	3.300
dialysis	1	1.700
multiple or days	1	1.700