IP - EM.1.other_factors

CM Codes

Data Overview

13914 total codes in komodo_rii; 63 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	52
MCC	6
CC	5

PCA Analysis

PC1 explains 55.9% of variance; PC1+PC2 together explain 74.3%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	organ system count	n distinct rev codes	length of stay	n j code lines	work rvu	relative claim charge	n imaging lines	n distinct hcps
1	16.000	105178.000	0.737	8.112	1.519	0.472	1.047	1.329	0.010	0.333
2	11.000	87890.000	3.782	9.102	3.706	1.464	2.113	2.451	0.249	0.567
3	20.000	129584.000	4.774	11.602	4.336	1.844	2.531	2.588	0.361	0.713
4	12.000	59341.000	5.322	10.761	5.200	2.901	3.416	1.979	0.444	0.827
5	4.000	14093.000	5.346	12.603	5.471	3.464	3.877	2.627	0.607	0.802

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	0	0	1	3	1	5
MCC	0	0	1	5	0	6
No CC/MCC	16	11	18	4	3	52
All	16	11	20	12	4	63

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_imaging_lines	0.336	-0.161	0.503
avg_organ_system_count	0.326	-0.197	0.488
avg_n_j_code_lines	0.319	-0.228	0.484
rate_icu	0.318	-0.132	0.500
rate_multiple_or_days	0.310	-0.213	0.377
avg_length_of_stay	0.298	-0.284	0.400
avg_n_distinct_hcps	0.278	-0.056	0.608
avg_work_rvu	0.276	-0.210	0.415
rate_dialysis	0.268	-0.165	0.514
rate_transfusion	0.255	-0.232	0.393
avg_n_distinct_rev_codes	0.240	-0.258	0.167
rate_mechanical_ventilation	0.163	-0.097	0.539
avg_relative_claim_charge	0.098	-0.235	-0.004
rate_or	0.093	0.010	-0.306

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I959	Hypotension, unspecified	No CC/MCC	4.594	5	2946	transfusion (+0.93), multiple or days (+0.75), mechanical ventilation (+0.49)
E876	Hypokalemia	No CC/MCC	4.476	5	3285	n j code lines (+0.80), n imaging lines (+0.66), multiple or days (+0.53)
E8720	Acidosis, unspecified	No CC/MCC	4.152	5	3819	n imaging lines (+0.65), multiple or days (+0.60), dialysis (+0.55)

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

None.

Top Codes by Tier

Tier 1 (n=16 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	-2.562	4450	work rvu (+0.79), n distinct rev codes (-0.71), n distinct hcps (-0.63)
O99344	Other mental disorders complicating childbirth	No CC/MCC	-3.775	4070	n imaging lines (-0.48), n distinct hcps (-0.47), icu (-0.42)
O76	Abnormality in fetal heart rate and rhythm complicating labor and delivery	No CC/MCC	-3.895	3975	organ system count (-0.49), n distinct hcps (-0.49), n imaging lines (-0.48)
O99214	Obesity complicating childbirth	No CC/MCC	-4.011	4558	n distinct hcps (-0.53), n imaging lines (-0.48), organ system count (-0.44)
O9902	Anemia complicating childbirth	No CC/MCC	-4.043	5010	n distinct hcps (-0.50), n imaging lines (-0.48), n j code lines (-0.44)
O700	First degree perineal laceration during delivery	No CC/MCC	-4.057	10183	organ system count (-0.52), n imaging lines (-0.49), icu (-0.43)
O701	Second degree perineal laceration during delivery	No CC/MCC	-4.105	2931	n distinct hcps (-0.65), organ system count (-0.53), n imaging lines (-0.48)
O480	Post-term pregnancy	No CC/MCC	-4.211	4977	organ system count (-0.53), n imaging lines (-0.48), icu (-0.44)
O99824	Streptococcus B carrier state complicating childbirth	No CC/MCC	-4.225	5355	organ system count (-0.50), n imaging lines (-0.49), n distinct hcps (-0.48)
O6981X0	Labor and delivery complicated by cord around neck, without compression, not applicable or unspecified	No CC/MCC	-4.236	6251	organ system count (-0.52), n distinct hcps (-0.50), n imaging lines (-0.49)

Tier 2 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	0.015	3577	n imaging lines (-0.10), length of stay (+0.10), dialysis (+0.09)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	-0.059	5317	organ system count (+0.16), icu (+0.15), multiple or days (-0.13)
I10	Essential (primary) hypertension	No CC/MCC	-0.192	29006	n distinct rev codes (-0.15), n imaging lines (+0.15), transfusion (-0.13)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-0.307	9421	n distinct rev codes (-0.22), dialysis (-0.16), work rvu (+0.11)
F419	Anxiety disorder, unspecified	No CC/MCC	-0.412	10680	length of stay (+0.16), dialysis (-0.16), transfusion (-0.15)
E782	Mixed hyperlipidemia	No CC/MCC	-0.836	3989	n distinct rev codes (-0.19), n distinct hcps (-0.17), transfusion (-0.16)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-1.015	10012	n distinct rev codes (-0.23), transfusion (-0.19), icu (-0.12)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-1.074	4929	multiple or days (-0.20), icu (-0.16), n imaging lines (-0.16)
L22	Diaper dermatitis	No CC/MCC	-1.739	3481	length of stay (-0.45), work rvu (-0.44), multiple or days (-0.42)
M810	Age-related osteoporosis without current pathological fracture	No CC/MCC	-1.885	4536	n distinct rev codes (-0.42), multiple or days (-0.30), n distinct hcps (-0.25)

Tier 3 (n=20 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5032	Chronic diastolic (congestive) heart failure	CC	1.875	4219	icu (+0.37), n distinct rev codes (+0.32), organ system count (+0.24)
G9341	Metabolic encephalopathy	MCC	1.753	4096	n imaging lines (+0.43), organ system count (+0.31), dialysis (+0.29)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	1.743	2948	organ system count (+0.31), n imaging lines (+0.27), multiple or days (+0.24)
G8929	Other chronic pain	No CC/MCC	1.668	3331	length of stay (+0.38), organ system count (+0.33), n j code lines (+0.30)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	1.503	5988	multiple or days (+0.36), organ system count (+0.26), n j code lines (+0.20)
I350	Nonrheumatic aortic (valve) stenosis	No CC/MCC	1.482	3833	icu (+0.69), n distinct rev codes (+0.60), or (+0.52)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	1.477	4313	organ system count (+0.29), icu (+0.26), n distinct rev codes (+0.22)
I4891	Unspecified atrial fibrillation	No CC/MCC	1.383	5686	multiple or days (+0.27), n distinct hcps (+0.24), organ system count (+0.19)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	1.344	4707	n imaging lines (+0.32), organ system count (+0.32), length of stay (+0.19)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	1.340	3231	organ system count (+0.33), n imaging lines (+0.27), length of stay (+0.25)

Tier 4 (n=12 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N179	Acute kidney failure, unspecified	CC	3.292	8567	n imaging lines (+0.45), multiple or days (+0.40), n j code lines (+0.39)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	3.204	5163	dialysis (+1.32), organ system count (+0.31), icu (+0.22)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	3.082	3067	icu (+0.56), n j code lines (+0.51), dialysis (+0.34)
J189	Pneumonia, unspecified organism	MCC	2.882	4343	n j code lines (+0.60), work rvu (+0.42), multiple or days (+0.38)
K5900	Constipation, unspecified	No CC/MCC	2.882	2974	length of stay (+0.76), n j code lines (+0.36), work rvu (+0.36)
N390	Urinary tract infection, site not specified	CC	2.845	3762	n imaging lines (+0.55), length of stay (+0.50), n j code lines (+0.37)
A419	Sepsis, unspecified organism	MCC	2.722	6668	n j code lines (+0.44), n imaging lines (+0.37), multiple or days (+0.33)
E43	Unspecified severe protein-calorie malnutrition	MCC	2.558	2914	length of stay (+0.48), multiple or days (+0.44), n imaging lines (+0.31)
I509	Heart failure, unspecified	No CC/MCC	2.531	3112	multiple or days (+0.61), n j code lines (+0.60), work rvu (+0.47)
D649	Anemia, unspecified	No CC/MCC	2.451	5599	transfusion (+0.51), multiple or days (+0.41), dialysis (+0.24)

Tier 5 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E871	Hypo-osmolality and hyponatremia	CC	4.848	4043	n imaging lines (+0.68), dialysis (+0.59), n j code lines (+0.58)
I959	Hypotension, unspecified	No CC/MCC	4.594	2946	transfusion (+0.93), multiple or days (+0.75), mechanical ventilation (+0.49)
E876	Hypokalemia	No CC/MCC	4.476	3285	n j code lines (+0.80), n imaging lines (+0.66), multiple or days (+0.53)
E8720	Acidosis, unspecified	No CC/MCC	4.152	3819	n imaging lines (+0.65), multiple or days (+0.60), dialysis (+0.55)

Key Driver Frequency

feature	count	pct
organ system count	30	47.600
n imaging lines	28	44.400
multiple or days	18	28.600
icu	18	28.600
length of stay	16	25.400
n distinct hcps	15	23.800
n distinct rev codes	14	22.200
n j code lines	13	20.600
work rvu	12	19.000
dialysis	11	17.500
transfusion	8	12.700
mechanical ventilation	3	4.800
or	2	3.200
relative claim charge	1	1.600

PCS Codes

Data Overview

1894 total codes in komodo_rii; 32 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 51.6% of variance; PC1+PC2 together explain 71.0%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	relative claim charge	n distinct rev codes	length of stay	mechanical ventilation	n j code lines	organ system count	work rvu	n distinct hcps
1	7.000	840538.000	0.923	6.721	0.238	0.005	0.423	0.016	0.008	0.874
2	12.000	179773.000	2.543	10.020	1.683	0.018	0.425	0.383	0.216	0.681
3	6.000	41814.000	6.984	14.235	0.828	0.153	0.722	0.273	0.300	0.914
4	5.000	26022.000	9.131	15.450	1.069	0.380	0.724	0.448	0.311	0.871
5	2.000	13762.000	11.853	16.926	1.612	0.522	0.954	0.564	0.578	0.924

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.335	-0.267
avg_n_imaging_lines	0.335	-0.283
avg_relative_claim_charge	0.312	-0.261
rate_transfusion	0.307	-0.291
rate_or	0.303	-0.244
avg_n_j_code_lines	0.298	-0.272
avg_work_rvu	0.289	-0.260
rate_mechanical_ventilation	0.278	-0.047
rate_icu	0.264	-0.322
rate_dialysis	0.259	0.063
avg_organ_system_count	0.210	-0.308
rate_multiple_or_days	0.210	-0.335
avg_n_distinct_hcps	0.109	-0.146
avg_length_of_stay	0.071	-0.453

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=7 codes)

code	Description	Score	N claims	Key drivers
0VTTXZZ	RESECTION OF PREPUCE, EXTERNAL APPROACH	-2.243	320125	or (+0.55), work rvu (-0.36), n distinct rev codes (-0.35)
F13ZLZZ	AUDITORY EVOKED POTENTIALS ASSESSMENT	-2.857	3904	or (-0.39), work rvu (-0.39), n distinct rev codes (-0.36)
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-2.895	450105	n distinct rev codes (-0.43), work rvu (-0.37), relative claim charge (-0.29)
F13ZM6Z	EVOKED OTOACOUSTIC EMISSIONS, SCREENING ASSESSMENT USING OTOACOUSTIC EMISSION (OAE) EQUIPMENT	-3.043	14457	n distinct rev codes (-0.48), work rvu (-0.39), or (-0.38)
3E0134Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO SUBCUTANEOUS TISSUE, PERCUTANEOUS APPROACH	-3.181	3697	n distinct rev codes (-0.44), or (-0.39), work rvu (-0.37)
F13Z0ZZ	HEARING SCREENING ASSESSMENT	-3.255	40501	or (-0.45), n distinct rev codes (-0.43), work rvu (-0.38)
F13ZL7Z	AUDITORY EVOKED POTENTIALS ASSESSMENT USING ELECTROPHYSIOLOGIC EQUIPMENT	-3.504	7749	n j code lines (-0.56), n distinct rev codes (-0.53), or (-0.43)

Tier 2 (n=12 codes)

code	Description	Score	N claims	Key drivers
3E0DXGC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO MOUTH AND PHARYNX, EXTERNAL APPROACH	-0.540	3013	multiple or days (+0.44), n imaging lines (-0.22), relative claim charge (-0.20)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.653	12246	n distinct rev codes (+0.26), work rvu (-0.21), organ system count (-0.16)
3E0P7VZ	INTRODUCTION OF HORMONE INTO FEMALE REPRODUCTIVE, VIA NATURAL OR ARTIFICIAL OPENING	-0.960	4336	n imaging lines (-0.23), n j code lines (-0.22), organ system count (+0.21)
4A1HXCZ	MONITORING OF PRODUCTS OF CONCEPTION, CARDIAC RATE, EXTERNAL APPROACH	-1.015	4478	n imaging lines (-0.22), relative claim charge (-0.22), n distinct rev codes (-0.17)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.109	48467	or (-0.19), transfusion (-0.19), relative claim charge (-0.16)
3E033VJ	INTRODUCTION OF OTHER HORMONE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.178	11518	n j code lines (-0.24), n imaging lines (-0.23), relative claim charge (-0.23)
0HQ9XZZ	REPAIR PERINEUM SKIN, EXTERNAL APPROACH	-1.446	6445	work rvu (+0.33), n j code lines (-0.32), or (-0.27)
6A601ZZ	PHOTOTHERAPY OF SKIN, MULTIPLE	-1.565	20896	work rvu (-0.30), organ system count (-0.20), multiple or days (-0.20)
0UQMXZZ	REPAIR VULVA, EXTERNAL APPROACH	-1.626	3559	n j code lines (-0.45), or (-0.26), organ system count (+0.25)
10907ZC	DRAINAGE OF AMNIOTIC FLUID, THERAPEUTIC FROM PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-1.710	18503	n j code lines (-0.36), relative claim charge (-0.24), n imaging lines (-0.23)

Tier 3 (n=6 codes)

code	Description	Score	N claims	Key drivers
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	1.821	9759	n j code lines (+0.45), multiple or days (+0.37), work rvu (+0.35)
3E0F7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	1.657	5690	relative claim charge (+0.49), transfusion (+0.48), n distinct rev codes (+0.44)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	1.526	4692	multiple or days (+0.44), n j code lines (+0.31), dialysis (+0.28)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	1.320	6481	n j code lines (+0.35), icu (+0.34), multiple or days (+0.23)
3E0336Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.986	10641	n distinct rev codes (+0.33), work rvu (+0.31), relative claim charge (+0.28)
5A0945A	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	0.435	4551	n distinct rev codes (+0.24), n j code lines (+0.22), transfusion (-0.15)

Tier 4 (n=5 codes)

code	Description	Score	N claims	Key drivers
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	3.897	4151	dialysis (+0.60), or (+0.54), transfusion (+0.48)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	3.730	6553	mechanical ventilation (+1.08), icu (+0.60), n imaging lines (+0.57)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	3.159	4764	n imaging lines (+0.93), icu (+0.91), n j code lines (+0.42)
5A09557	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	2.832	4832	relative claim charge (+0.82), n distinct rev codes (+0.59), transfusion (+0.55)
06H033T	INSERTION OF INFUSION DEVICE, VIA UMBILICAL VEIN, INTO INFERIOR VENA CAVA, PERCUTANEOUS APPROACH	2.618	5722	transfusion (+0.57), or (+0.48), n distinct rev codes (+0.43)

Tier 5 (n=2 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	6.960	10743	dialysis (+1.09), mechanical ventilation (+0.73), n imaging lines (+0.70)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	5.603	3019	transfusion (+0.91), n imaging lines (+0.73), relative claim charge (+0.73)

Key Driver Frequency

feature	count	pct
n distinct rev codes	14	43.800
n j code lines	12	37.500
work rvu	12	37.500
or	11	34.400
n imaging lines	10	31.200
relative claim charge	10	31.200
transfusion	7	21.900
organ system count	6	18.800
multiple or days	5	15.600
dialysis	3	9.400
icu	3	9.400
mechanical ventilation	2	6.200
n distinct hcps	1	3.100