IP - EM.1.sepsis

CM Codes

Data Overview

22402 total codes in komodo_rii; 554 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	291
CC	163
MCC	100

PCA Analysis

PC1 explains 47.5% of variance; PC1+PC2 together explain 60.2%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	work rvu	n imaging lines	n j code lines	organ system count	icu
1	304.000	13020810.000	6.897	17.443	0.941	0.498	1.145	0.487	6.763	0.421
2	200.000	5009772.000	8.577	19.240	1.258	0.671	1.284	0.604	6.600	0.541
3	50.000	874234.000	11.031	21.536	1.828	1.045	1.538	0.813	6.495	0.651

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	71	76	16	163
MCC	14	56	30	100
No CC/MCC	219	68	4	291
All	304	200	50	554

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.369	-0.007	0.549
avg_n_distinct_rev_codes	0.351	0.008	0.403
avg_length_of_stay	0.336	-0.059	0.445
rate_icu	0.310	0.103	0.451
rate_or	0.303	-0.104	0.404
rate_multiple_or_days	0.300	-0.061	0.399
rate_mechanical_ventilation	0.297	0.098	0.510
rate_transfusion	0.274	-0.005	0.434
avg_n_imaging_lines	0.254	-0.087	0.256
avg_n_j_code_lines	0.251	-0.109	0.428
rate_dialysis	0.170	0.126	0.415
avg_work_rvu	0.157	-0.038	0.308
avg_n_distinct_hcps	0.045	-0.153	-0.324
avg_organ_system_count	-0.061	-0.020	-0.650

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K7682	Hepatic encephalopathy	No CC/MCC	4.969	3	15310	multiple or days (+0.73), or (+0.59), n distinct rev codes (+0.59)
Q2112	Patent foramen ovale	No CC/MCC	4.821	3	3902	work rvu (+2.58), relative claim charge (+0.71), length of stay (+0.48)
K7031	Alcoholic cirrhosis of liver with ascites	No CC/MCC	4.674	3	11683	multiple or days (+1.13), or (+0.92), transfusion (+0.67)
G928	Other toxic encephalopathy	No CC/MCC	3.799	3	115585	n imaging lines (+0.69), n distinct rev codes (+0.61), icu (+0.52)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J129	Viral pneumonia, unspecified	MCC	-2.271	1	8090	or (-0.41), n imaging lines (-0.38), length of stay (-0.32)
J1000	Influenza due to other identified influenza virus with unspecified type of pneumonia	MCC	-1.929	1	14941	n imaging lines (-0.43), or (-0.40), length of stay (-0.30)
A4189	Other specified sepsis	MCC	-1.847	1	143220	or (-0.37), n distinct rev codes (-0.31), n imaging lines (-0.30)
J157	Pneumonia due to Mycoplasma pneumoniae	MCC	-1.760	1	4562	multiple or days (-0.43), n imaging lines (-0.40), length of stay (-0.30)
A4151	Sepsis due to Escherichia coli [E. coli]	MCC	-1.569	1	159057	n distinct rev codes (-0.27), relative claim charge (-0.27), length of stay (-0.26)

Top Codes by Tier

Tier 1 (n=304 codes)

code	Description	CMS severity	Score	N claims	Key drivers
B954	Other streptococcus as the cause of diseases classified elsewhere	No CC/MCC	-0.283	4515	or (+0.54), icu (-0.49), multiple or days (+0.36)
E038	Other specified hypothyroidism	No CC/MCC	-0.288	4923	multiple or days (-0.23), or (-0.16), length of stay (+0.13)
C7800	Secondary malignant neoplasm of unspecified lung	CC	-0.288	11827	transfusion (+0.28), length of stay (-0.22), relative claim charge (-0.19)
K838	Other specified diseases of biliary tract	No CC/MCC	-0.304	5877	n imaging lines (+0.44), length of stay (-0.25), mechanical ventilation (-0.20)
L02415	Cutaneous abscess of right lower limb	CC	-0.331	4106	or (+0.80), icu (-0.56), multiple or days (+0.39)
K7689	Other specified diseases of liver	No CC/MCC	-0.332	6402	n imaging lines (+0.30), length of stay (-0.15), icu (-0.14)
I351	Nonrheumatic aortic (valve) insufficiency	No CC/MCC	-0.336	4438	multiple or days (-0.23), n distinct rev codes (+0.14), transfusion (-0.11)
C3412	Malignant neoplasm of upper lobe, left bronchus or lung	CC	-0.346	3823	multiple or days (-0.26), length of stay (-0.12), dialysis (-0.11)
B9561	Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere	No CC/MCC	-0.352	7071	icu (-0.48), multiple or days (+0.37), or (+0.37)
I959	Hypotension, unspecified	No CC/MCC	-0.381	86052	work rvu (+0.17), relative claim charge (-0.16), length of stay (-0.14)

Tier 2 (n=200 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N186	End stage renal disease	MCC	3.502	82746	dialysis (+1.83), relative claim charge (+0.32), transfusion (+0.26)
I5021	Acute systolic (congestive) heart failure	MCC	3.474	14900	icu (+0.64), n distinct rev codes (+0.63), relative claim charge (+0.58)
K659	Peritonitis, unspecified	MCC	3.438	5132	or (+0.69), multiple or days (+0.50), n j code lines (+0.44)
J810	Acute pulmonary edema	MCC	3.352	11668	n distinct rev codes (+0.55), icu (+0.54), relative claim charge (+0.41)
G9389	Other specified disorders of brain	No CC/MCC	3.332	5882	n imaging lines (+1.06), n distinct rev codes (+0.55), n j code lines (+0.51)
K766	Portal hypertension	CC	3.277	23017	or (+0.59), multiple or days (+0.58), transfusion (+0.51)
K631	Perforation of intestine (nontraumatic)	MCC	3.253	4404	multiple or days (+1.11), n j code lines (+0.67), or (+0.40)
I5181	Takotsubo syndrome	CC	3.243	3653	n distinct rev codes (+0.61), icu (+0.61), relative claim charge (+0.53)
K831	Obstruction of bile duct	MCC	3.204	12298	multiple or days (+0.82), n j code lines (+0.63), or (+0.57)
I8510	Secondary esophageal varices without bleeding	CC	3.188	7491	multiple or days (+0.75), or (+0.59), transfusion (+0.50)

Tier 3 (n=50 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J95851	Ventilator associated pneumonia	CC	11.076	4764	mechanical ventilation (+2.27), relative claim charge (+2.19), length of stay (+1.72)
J80	Acute respiratory distress syndrome	MCC	11.067	19598	relative claim charge (+2.08), mechanical ventilation (+1.92), icu (+1.17)
I469	Cardiac arrest, cause unspecified	MCC	10.314	9391	mechanical ventilation (+2.37), relative claim charge (+1.46), icu (+1.16)
G7281	Critical illness myopathy	CC	10.256	5094	length of stay (+2.13), relative claim charge (+1.92), n distinct rev codes (+1.35)
D65	Disseminated intravascular coagulation [defibrination syndrome]	MCC	9.785	9710	relative claim charge (+1.54), transfusion (+1.40), mechanical ventilation (+1.31)
I76	Septic arterial embolism	CC	7.984	3870	n imaging lines (+1.36), multiple or days (+1.11), relative claim charge (+1.02)
J15211	Pneumonia due to Methicillin susceptible Staphylococcus aureus	MCC	7.792	8338	relative claim charge (+1.38), mechanical ventilation (+1.17), length of stay (+1.00)
J948	Other specified pleural conditions	CC	7.565	3685	multiple or days (+1.41), or (+1.08), n j code lines (+0.88)
K767	Hepatorenal syndrome	MCC	7.555	8847	transfusion (+1.02), multiple or days (+0.97), or (+0.95)
G061	Intraspinal abscess and granuloma	MCC	7.510	3745	multiple or days (+1.46), n imaging lines (+1.45), n j code lines (+1.11)

Key Driver Frequency

feature	count	pct
relative claim charge	256	46.200
n distinct rev codes	229	41.300
length of stay	197	35.600
icu	183	33.000
or	170	30.700
n j code lines	157	28.300
multiple or days	154	27.800
n imaging lines	114	20.600
transfusion	94	17.000
mechanical ventilation	73	13.200
work rvu	17	3.100
dialysis	16	2.900
organ system count	2	0.400

PCS Codes

Data Overview

6724 total codes in komodo_rii; 105 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 38.5% of variance; PC1+PC2 together explain 52.0%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	work rvu	n imaging lines	organ system count	n j code lines	or
1	6.000	133575.000	16.498	7.053	1.045	0.290	1.076	5.686	0.631	0.140
2	39.000	544387.000	20.618	9.277	1.542	0.685	1.347	5.945	0.693	0.411
3	36.000	800745.000	22.459	10.998	1.929	0.825	1.522	6.123	0.870	0.487
4	24.000	420590.000	24.206	13.177	2.472	0.958	1.638	6.222	1.070	0.573

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.387	0.031
avg_n_distinct_rev_codes	0.381	-0.035
avg_length_of_stay	0.333	-0.101
rate_icu	0.273	0.284
rate_multiple_or_days	0.273	-0.216
avg_n_imaging_lines	0.267	0.081
rate_transfusion	0.258	-0.010
avg_organ_system_count	0.257	0.016
rate_mechanical_ventilation	0.244	0.251
rate_or	0.242	-0.236
rate_dialysis	0.222	0.226
avg_n_j_code_lines	0.184	-0.064
avg_n_distinct_hcps	0.168	-0.225
avg_work_rvu	0.109	0.190

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
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-4.841	10949	n distinct rev codes (-0.69), relative claim charge (-0.64), n distinct hcps (-0.54)
3E0333Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-4.893	9866	n distinct rev codes (-0.80), relative claim charge (-0.53), organ system count (-0.52)
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	-5.080	41661	n distinct rev codes (-0.87), relative claim charge (-0.56), n imaging lines (-0.52)
8E0ZXY6	ISOLATION	-5.338	31354	n distinct rev codes (-1.08), relative claim charge (-0.63), icu (-0.51)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-5.375	4554	n distinct rev codes (-0.95), relative claim charge (-0.76), organ system count (-0.58)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-6.031	35191	n distinct rev codes (-1.17), relative claim charge (-0.80), length of stay (-0.65)

Tier 2 (n=39 codes)

code	Description	Score	N claims	Key drivers
4A03X5D	MEASUREMENT OF ARTERIAL FLOW, INTRACRANIAL, EXTERNAL APPROACH	-0.576	5368	n imaging lines (+1.19), multiple or days (-0.38), or (-0.33)
0W9G30Z	DRAINAGE OF PERITONEAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-0.658	6595	or (+0.43), organ system count (-0.42), icu (-0.38)
5A0955A	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-0.690	6759	organ system count (-0.55), length of stay (+0.50), relative claim charge (+0.35)
0D9670Z	DRAINAGE OF STOMACH WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-0.700	5521	n distinct rev codes (-0.31), n distinct hcps (+0.14), or (-0.14)
5A09557	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.719	5819	relative claim charge (+0.47), length of stay (+0.41), multiple or days (-0.34)
0DB98ZX	EXCISION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.746	6612	icu (-0.31), n distinct rev codes (+0.24), mechanical ventilation (-0.24)
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	-0.835	6059	icu (-0.29), n imaging lines (+0.23), transfusion (-0.21)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.910	61549	icu (+0.40), length of stay (-0.30), n distinct rev codes (-0.23)
30233J1	TRANSFUSION OF NONAUTOLOGOUS SERUM ALBUMIN INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.005	4197	multiple or days (-0.34), n distinct rev codes (-0.24), icu (+0.16)
05H933Z	INSERTION OF INFUSION DEVICE INTO RIGHT BRACHIAL VEIN, PERCUTANEOUS APPROACH	-1.030	7959	n distinct hcps (-0.27), relative claim charge (-0.23), icu (-0.16)

Tier 3 (n=36 codes)

code	Description	Score	N claims	Key drivers
05HN33Z	INSERTION OF INFUSION DEVICE INTO LEFT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	1.763	4852	icu (+0.40), dialysis (+0.28), organ system count (+0.27)
4A00X4Z	MEASUREMENT OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	1.714	5123	n imaging lines (+0.82), n j code lines (+0.39), organ system count (+0.34)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	1.563	20705	length of stay (+0.55), relative claim charge (+0.32), n distinct hcps (+0.17)
B543ZZA	ULTRASONOGRAPHY OF RIGHT JUGULAR VEINS, GUIDANCE	1.547	5121	icu (+0.36), multiple or days (+0.30), dialysis (+0.24)
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	1.442	14028	icu (+0.38), work rvu (+0.36), mechanical ventilation (+0.24)
04HY32Z	INSERTION OF MONITORING DEVICE INTO LOWER ARTERY, PERCUTANEOUS APPROACH	1.442	9992	mechanical ventilation (+0.45), icu (+0.43), relative claim charge (+0.26)
0W9930Z	DRAINAGE OF RIGHT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	1.421	12662	multiple or days (+0.42), relative claim charge (+0.35), organ system count (-0.32)
30233R1	TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.392	12910	transfusion (+0.91), relative claim charge (+0.19), n distinct hcps (+0.17)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	1.331	4530	length of stay (+0.68), relative claim charge (+0.57), organ system count (-0.24)
05HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	1.285	14053	icu (+0.34), dialysis (+0.27), organ system count (+0.20)

Tier 4 (n=24 codes)

code	Description	Score	N claims	Key drivers
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	5.243	12069	dialysis (+1.03), relative claim charge (+0.84), organ system count (+0.60)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	4.559	16082	dialysis (+0.86), length of stay (+0.80), n distinct rev codes (+0.80)
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	4.448	61552	relative claim charge (+1.19), mechanical ventilation (+0.77), length of stay (+0.72)
0BJ08ZZ	INSPECTION OF TRACHEOBRONCHIAL TREE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	4.038	5770	relative claim charge (+0.94), length of stay (+0.59), mechanical ventilation (+0.47)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	3.924	7588	multiple or days (+0.92), relative claim charge (+0.69), n distinct rev codes (+0.55)
02PYX3Z	REMOVAL OF INFUSION DEVICE FROM GREAT VESSEL, EXTERNAL APPROACH	3.569	4219	length of stay (+0.61), dialysis (+0.53), organ system count (+0.48)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	3.487	12498	length of stay (+1.17), relative claim charge (+0.68), n distinct rev codes (+0.66)
0B9F8ZX	DRAINAGE OF RIGHT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	3.176	9302	relative claim charge (+0.64), multiple or days (+0.59), n distinct rev codes (+0.46)
0B9J8ZX	DRAINAGE OF LEFT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	3.110	7654	relative claim charge (+0.71), n distinct rev codes (+0.44), multiple or days (+0.43)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	3.063	9412	length of stay (+0.52), relative claim charge (+0.49), n j code lines (+0.45)

Key Driver Frequency

feature	count	pct
relative claim charge	55	52.400
n distinct rev codes	47	44.800
organ system count	34	32.400
icu	33	31.400
multiple or days	28	26.700
length of stay	25	23.800
or	21	20.000
mechanical ventilation	16	15.200
n distinct hcps	15	14.300
transfusion	13	12.400
n imaging lines	11	10.500
dialysis	9	8.600
work rvu	4	3.800
n j code lines	4	3.800