IP - EM.1.unplanned_or
CM Codes
Data Overview
18537 total codes in komodo_rii; 452 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 248 |
| CC | 143 |
| MCC | 61 |
PCA Analysis
PC1 explains 39.0% of variance; PC1+PC2 together explain 56.0%.



Tier Clustering (k=5)

Tier Summary
| tier | n_codes | n_claims | length of stay | n distinct rev codes | organ system count | work rvu | n imaging lines | relative claim charge | n j code lines | icu |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 22.000 | 38431.000 | 4.771 | 15.229 | 4.165 | 1.381 | 0.320 | 0.626 | 1.144 | 0.152 |
| 2 | 115.000 | 369539.000 | 8.073 | 19.318 | 6.021 | 2.491 | 0.798 | 0.925 | 1.481 | 0.297 |
| 3 | 154.000 | 389041.000 | 10.598 | 21.731 | 6.013 | 2.553 | 1.112 | 1.098 | 1.492 | 0.430 |
| 4 | 112.000 | 251264.000 | 13.312 | 23.466 | 6.024 | 2.467 | 1.284 | 1.339 | 1.601 | 0.528 |
| 5 | 49.000 | 77618.000 | 17.683 | 25.918 | 6.154 | 2.933 | 1.704 | 1.734 | 2.117 | 0.674 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 | All |
|---|---|---|---|---|---|---|
| CC | 5 | 17 | 61 | 44 | 16 | 143 |
| MCC | 0 | 0 | 8 | 25 | 28 | 61 |
| No CC/MCC | 17 | 98 | 85 | 43 | 5 | 248 |
| All | 22 | 115 | 154 | 112 | 49 | 452 |
Feature Analysis
Feature Correlation

Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_distinct_rev_codes | 0.408 | -0.024 | 0.558 |
| avg_relative_claim_charge | 0.367 | -0.037 | 0.502 |
| avg_length_of_stay | 0.363 | 0.001 | 0.592 |
| rate_icu | 0.361 | -0.007 | 0.420 |
| avg_n_imaging_lines | 0.335 | -0.133 | 0.492 |
| rate_mechanical_ventilation | 0.334 | 0.008 | 0.504 |
| rate_transfusion | 0.318 | -0.048 | 0.446 |
| rate_dialysis | 0.168 | 0.126 | 0.360 |
| avg_organ_system_count | 0.161 | 0.040 | -0.163 |
| avg_n_distinct_hcps | 0.119 | -0.056 | -0.250 |
| rate_multiple_or_days | 0.116 | -0.006 | 0.019 |
| avg_n_j_code_lines | 0.115 | -0.059 | -0.072 |
| avg_work_rvu | 0.066 | -0.034 | -0.096 |
| rate_or | -0.114 | -0.099 | -0.215 |
Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation



Misclassification Audit (N=10 samples)
Over-tiered: Tier 5, No CC/MCC (5 codes)
| code | code_description | cms_severity | intensity_score | tier | n_claims | key_drivers |
|---|---|---|---|---|---|---|
| G928 | Other toxic encephalopathy | No CC/MCC | 4.171 | 5 | 3946 | n distinct rev codes (+0.78), n imaging lines (+0.71), length of stay (+0.66) |
| K683 | Retroperitoneal hematoma | No CC/MCC | 3.783 | 5 | 584 | transfusion (+1.17), relative claim charge (+0.65), icu (+0.62) |
| K7031 | Alcoholic cirrhosis of liver with ascites | No CC/MCC | 3.560 | 5 | 1049 | transfusion (+0.93), n distinct rev codes (+0.59), icu (+0.50) |
| K7682 | Hepatic encephalopathy | No CC/MCC | 3.410 | 5 | 984 | transfusion (+0.73), n distinct rev codes (+0.59), relative claim charge (+0.42) |
| S065XAA | Traumatic subdural hemorrhage with loss of consciousness status unknown, initial encounter | No CC/MCC | 3.406 | 5 | 718 | n imaging lines (+0.96), icu (+0.84), mechanical ventilation (+0.63) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=22 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| I6522 | Occlusion and stenosis of left carotid artery | No CC/MCC | -3.886 | 1456 | n distinct rev codes (-0.92), length of stay (-0.68), relative claim charge (-0.61) |
| K430 | Incisional hernia with obstruction, without gangrene | CC | -3.954 | 503 | n distinct rev codes (-0.71), n imaging lines (-0.55), length of stay (-0.49) |
| L03113 | Cellulitis of right upper limb | CC | -3.992 | 984 | n distinct rev codes (-0.71), icu (-0.64), relative claim charge (-0.64) |
| I6521 | Occlusion and stenosis of right carotid artery | No CC/MCC | -4.014 | 1613 | n distinct rev codes (-0.88), length of stay (-0.69), relative claim charge (-0.62) |
| K449 | Diaphragmatic hernia without obstruction or gangrene | No CC/MCC | -4.021 | 4181 | n distinct rev codes (-0.82), length of stay (-0.56), n imaging lines (-0.52) |
| D259 | Leiomyoma of uterus, unspecified | No CC/MCC | -4.102 | 693 | n distinct rev codes (-0.82), length of stay (-0.56), icu (-0.52) |
| K660 | Peritoneal adhesions (postprocedural) (postinfection) | No CC/MCC | -4.179 | 2371 | n distinct rev codes (-0.91), n imaging lines (-0.60), icu (-0.57) |
| N321 | Vesicointestinal fistula | CC | -4.208 | 751 | n distinct rev codes (-0.78), icu (-0.61), n imaging lines (-0.50) |
| M1612 | Unilateral primary osteoarthritis, left hip | No CC/MCC | -4.263 | 1176 | icu (-0.76), n imaging lines (-0.67), n distinct rev codes (-0.59) |
| M1611 | Unilateral primary osteoarthritis, right hip | No CC/MCC | -4.358 | 1315 | icu (-0.72), n imaging lines (-0.66), n distinct rev codes (-0.59) |
Tier 2 (n=115 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| H547 | Unspecified visual loss | No CC/MCC | -1.136 | 573 | transfusion (-0.36), relative claim charge (-0.34), length of stay (-0.31) |
| N401 | Benign prostatic hyperplasia with lower urinary tract symptoms | No CC/MCC | -1.139 | 2128 | transfusion (-0.19), mechanical ventilation (-0.19), icu (-0.18) |
| H409 | Unspecified glaucoma | No CC/MCC | -1.147 | 1075 | relative claim charge (-0.28), organ system count (+0.22), length of stay (-0.21) |
| M109 | Gout, unspecified | No CC/MCC | -1.150 | 2443 | n imaging lines (-0.27), length of stay (-0.26), n distinct rev codes (-0.24) |
| N200 | Calculus of kidney | No CC/MCC | -1.155 | 624 | length of stay (-0.26), icu (-0.26), n distinct rev codes (-0.23) |
| G894 | Chronic pain syndrome | No CC/MCC | -1.173 | 1308 | icu (-0.28), organ system count (+0.25), transfusion (-0.23) |
| E1151 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene | No CC/MCC | -1.193 | 4761 | relative claim charge (-0.21), mechanical ventilation (-0.19), n imaging lines (-0.17) |
| M47816 | Spondylosis without myelopathy or radiculopathy, lumbar region | No CC/MCC | -1.203 | 574 | icu (-0.41), transfusion (-0.30), length of stay (-0.28) |
| I951 | Orthostatic hypotension | No CC/MCC | -1.226 | 1976 | icu (-0.27), mechanical ventilation (-0.26), relative claim charge (-0.17) |
| E1140 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified | No CC/MCC | -1.240 | 3468 | relative claim charge (-0.28), icu (-0.21), transfusion (-0.20) |
Tier 3 (n=154 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| E2740 | Unspecified adrenocortical insufficiency | CC | 0.653 | 863 | relative claim charge (+0.18), icu (+0.17), length of stay (+0.14) |
| N179 | Acute kidney failure, unspecified | CC | 0.650 | 23862 | n distinct rev codes (+0.21), transfusion (+0.13), icu (+0.11) |
| D84821 | Immunodeficiency due to drugs | No CC/MCC | 0.616 | 2018 | transfusion (+0.22), dialysis (+0.22), mechanical ventilation (-0.12) |
| E869 | Volume depletion, unspecified | No CC/MCC | 0.613 | 561 | n distinct rev codes (+0.23), n distinct hcps (+0.19), transfusion (+0.15) |
| I5A | Non-ischemic myocardial injury (non-traumatic) | No CC/MCC | 0.598 | 657 | n imaging lines (+0.30), n distinct rev codes (+0.24), or (+0.20) |
| C7951 | Secondary malignant neoplasm of bone | CC | 0.582 | 2136 | n imaging lines (+0.55), n distinct rev codes (+0.29), mechanical ventilation (-0.16) |
| N3000 | Acute cystitis without hematuria | CC | 0.577 | 1055 | n distinct rev codes (+0.30), n imaging lines (+0.27), length of stay (+0.25) |
| T82858A | Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter | CC | 0.569 | 598 | dialysis (+0.99), n distinct rev codes (-0.18), organ system count (+0.17) |
| I452 | Bifascicular block | CC | 0.568 | 607 | or (+0.21), icu (+0.17), n distinct rev codes (+0.15) |
| I214 | Non-ST elevation (NSTEMI) myocardial infarction | MCC | 0.568 | 4765 | or (+0.50), icu (+0.37), relative claim charge (+0.23) |
Tier 4 (n=112 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| Q250 | Patent ductus arteriosus | CC | 2.874 | 811 | relative claim charge (+2.63), mechanical ventilation (+1.55), organ system count (-0.78) |
| J9621 | Acute and chronic respiratory failure with hypoxia | MCC | 2.841 | 5948 | length of stay (+0.74), mechanical ventilation (+0.66), relative claim charge (+0.50) |
| K659 | Peritonitis, unspecified | MCC | 2.739 | 841 | relative claim charge (+0.49), length of stay (+0.45), dialysis (+0.39) |
| E8729 | Other acidosis | No CC/MCC | 2.669 | 1682 | mechanical ventilation (+0.60), icu (+0.59), relative claim charge (+0.51) |
| J1282 | Pneumonia due to coronavirus disease 2019 | No CC/MCC | 2.660 | 874 | length of stay (+0.64), relative claim charge (+0.59), n distinct rev codes (+0.48) |
| J9601 | Acute respiratory failure with hypoxia | MCC | 2.652 | 19289 | mechanical ventilation (+0.66), icu (+0.50), n distinct rev codes (+0.47) |
| K922 | Gastrointestinal hemorrhage, unspecified | CC | 2.643 | 1810 | transfusion (+1.07), icu (+0.37), n distinct rev codes (+0.36) |
| I5021 | Acute systolic (congestive) heart failure | MCC | 2.617 | 1176 | icu (+0.57), n distinct rev codes (+0.48), relative claim charge (+0.43) |
| J90 | Pleural effusion, not elsewhere classified | CC | 2.581 | 4976 | n distinct rev codes (+0.44), icu (+0.36), relative claim charge (+0.34) |
| L89153 | Pressure ulcer of sacral region, stage 3 | MCC | 2.467 | 1014 | length of stay (+1.08), transfusion (+0.28), relative claim charge (+0.28) |
Tier 5 (n=49 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| J80 | Acute respiratory distress syndrome | MCC | 8.852 | 553 | mechanical ventilation (+2.08), relative claim charge (+1.79), length of stay (+1.12) |
| I469 | Cardiac arrest, cause unspecified | MCC | 6.973 | 863 | mechanical ventilation (+1.88), relative claim charge (+1.10), icu (+0.91) |
| J151 | Pneumonia due to Pseudomonas | MCC | 6.768 | 547 | length of stay (+1.60), mechanical ventilation (+1.53), relative claim charge (+1.26) |
| K7200 | Acute and subacute hepatic failure without coma | MCC | 6.524 | 1221 | relative claim charge (+1.18), mechanical ventilation (+1.18), n distinct rev codes (+0.99) |
| I330 | Acute and subacute infective endocarditis | MCC | 6.504 | 660 | length of stay (+1.10), n distinct rev codes (+0.96), relative claim charge (+0.90) |
| G931 | Anoxic brain damage, not elsewhere classified | CC | 5.860 | 560 | mechanical ventilation (+1.96), length of stay (+0.99), relative claim charge (+0.76) |
| G7281 | Critical illness myopathy | CC | 5.686 | 516 | length of stay (+1.71), mechanical ventilation (+1.06), relative claim charge (+0.71) |
| A4101 | Sepsis due to Methicillin susceptible Staphylococcus aureus | MCC | 5.205 | 508 | relative claim charge (+1.00), n distinct rev codes (+0.89), length of stay (+0.82) |
| E874 | Mixed disorder of acid-base balance | CC | 5.017 | 1130 | mechanical ventilation (+0.98), relative claim charge (+0.77), n distinct rev codes (+0.77) |
| A4159 | Other Gram-negative sepsis | MCC | 4.998 | 513 | length of stay (+1.10), relative claim charge (+0.80), n distinct rev codes (+0.77) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n distinct rev codes | 248 | 54.900 |
| icu | 225 | 49.800 |
| length of stay | 183 | 40.500 |
| relative claim charge | 175 | 38.700 |
| transfusion | 141 | 31.200 |
| n imaging lines | 136 | 30.100 |
| mechanical ventilation | 83 | 18.400 |
| organ system count | 43 | 9.500 |
| dialysis | 30 | 6.600 |
| or | 29 | 6.400 |
| n j code lines | 22 | 4.900 |
| multiple or days | 21 | 4.600 |
| n distinct hcps | 16 | 3.500 |
| work rvu | 4 | 0.900 |

PCS Codes
Data Overview
16687 total codes in komodo_rii; 178 retained after n_claims > 500 filter.
PCA Analysis
PC1 explains 46.0% of variance; PC1+PC2 together explain 60.3%.



Tier Clustering (k=5)

Tier Summary
| tier | n_codes | n_claims | length of stay | n distinct rev codes | work rvu | n j code lines | organ system count | relative claim charge | n imaging lines | icu |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 25.000 | 30582.000 | 4.677 | 15.283 | 0.720 | 0.820 | 3.887 | 0.669 | 0.371 | 0.196 |
| 2 | 48.000 | 68723.000 | 9.205 | 20.894 | 2.045 | 1.073 | 5.241 | 1.167 | 1.029 | 0.394 |
| 3 | 43.000 | 56079.000 | 13.009 | 23.323 | 2.371 | 1.537 | 5.633 | 1.402 | 1.182 | 0.495 |
| 4 | 47.000 | 80184.000 | 15.573 | 25.727 | 3.727 | 2.628 | 5.590 | 1.848 | 1.360 | 0.653 |
| 5 | 15.000 | 27894.000 | 18.461 | 27.736 | 4.740 | 4.245 | 5.772 | 2.257 | 1.790 | 0.774 |
Feature Analysis
Feature Correlation

Feature Audit
| pc1_loading | r_with_volume | |
|---|---|---|
| avg_n_distinct_rev_codes | 0.365 | 0.153 |
| avg_relative_claim_charge | 0.335 | 0.085 |
| rate_icu | 0.306 | 0.183 |
| avg_length_of_stay | 0.305 | 0.116 |
| rate_transfusion | 0.304 | 0.151 |
| avg_n_j_code_lines | 0.295 | 0.099 |
| rate_multiple_or_days | 0.286 | 0.061 |
| avg_n_imaging_lines | 0.278 | 0.073 |
| rate_mechanical_ventilation | 0.271 | 0.188 |
| avg_organ_system_count | 0.253 | 0.010 |
| avg_work_rvu | 0.223 | 0.004 |
| avg_n_distinct_hcps | 0.137 | 0.192 |
| rate_dialysis | 0.126 | 0.234 |
| rate_or | 0.089 | -0.174 |
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 |
|---|---|---|---|---|
| 0RRJ00Z | REPLACEMENT OF RIGHT SHOULDER JOINT WITH REVERSE BALL AND SOCKET SYNTHETIC SUBSTITUTE, OPEN APPROACH | -2.858 | 533 | icu (-0.37), length of stay (-0.34), transfusion (-0.34) |
| 0JDQ0ZZ | EXTRACTION OF RIGHT FOOT SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH | -2.956 | 589 | relative claim charge (-0.51), n distinct rev codes (-0.45), icu (-0.41) |
| 0DNW4ZZ | RELEASE PERITONEUM, PERCUTANEOUS ENDOSCOPIC APPROACH | -2.995 | 712 | n distinct rev codes (-0.51), icu (-0.39), relative claim charge (-0.35) |
| 0JDR0ZZ | EXTRACTION OF LEFT FOOT SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH | -3.030 | 582 | relative claim charge (-0.51), n distinct rev codes (-0.47), icu (-0.40) |
| 03UL0KZ | SUPPLEMENT LEFT INTERNAL CAROTID ARTERY WITH NONAUTOLOGOUS TISSUE SUBSTITUTE, OPEN APPROACH | -3.189 | 747 | n distinct rev codes (-0.57), relative claim charge (-0.52), length of stay (-0.45) |
| 0DTJ4ZZ | RESECTION OF APPENDIX, PERCUTANEOUS ENDOSCOPIC APPROACH | -3.201 | 966 | relative claim charge (-0.47), icu (-0.45), n distinct rev codes (-0.45) |
| 03UK0KZ | SUPPLEMENT RIGHT INTERNAL CAROTID ARTERY WITH NONAUTOLOGOUS TISSUE SUBSTITUTE, OPEN APPROACH | -3.343 | 818 | n distinct rev codes (-0.57), relative claim charge (-0.53), length of stay (-0.45) |
| 0WQF4ZZ | REPAIR ABDOMINAL WALL, PERCUTANEOUS ENDOSCOPIC APPROACH | -3.361 | 563 | n distinct rev codes (-0.49), icu (-0.41), n imaging lines (-0.39) |
| 0SRD0J9 | REPLACEMENT OF LEFT KNEE JOINT WITH SYNTHETIC SUBSTITUTE, CEMENTED, OPEN APPROACH | -3.480 | 1689 | icu (-0.51), n distinct rev codes (-0.43), n imaging lines (-0.43) |
| 8E0W4CZ | ROBOTIC ASSISTED PROCEDURE OF TRUNK REGION, PERCUTANEOUS ENDOSCOPIC APPROACH | -3.530 | 6314 | n distinct rev codes (-0.63), icu (-0.42), relative claim charge (-0.41) |
Tier 2 (n=48 codes)
| code | Description | Score | N claims | Key drivers |
|---|---|---|---|---|
| 02F03ZZ | FRAGMENTATION IN CORONARY ARTERY, ONE ARTERY, PERCUTANEOUS APPROACH | -0.720 | 740 | multiple or days (-0.27), or (-0.19), length of stay (-0.17) |
| 0QS736Z | REPOSITION LEFT UPPER FEMUR WITH INTRAMEDULLARY INTERNAL FIXATION DEVICE, PERCUTANEOUS APPROACH | -0.753 | 561 | icu (-0.37), organ system count (+0.28), relative claim charge (-0.27) |
| 0JPT0PZ | REMOVAL OF CARDIAC RHYTHM RELATED DEVICE FROM TRUNK SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH | -0.780 | 501 | n j code lines (-0.17), transfusion (-0.17), work rvu (-0.15) |
| 027V3ZZ | DILATION OF SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH | -0.799 | 513 | dialysis (+0.51), relative claim charge (-0.34), n j code lines (-0.22) |
| 0QU03JZ | SUPPLEMENT LUMBAR VERTEBRA WITH SYNTHETIC SUBSTITUTE, PERCUTANEOUS APPROACH | -0.912 | 998 | n imaging lines (+0.51), transfusion (-0.31), n j code lines (-0.29) |
| 0SG3071 | FUSION OF LUMBOSACRAL JOINT WITH AUTOLOGOUS TISSUE SUBSTITUTE, POSTERIOR APPROACH, POSTERIOR COLUMN, OPEN APPROACH | -0.939 | 588 | work rvu (+0.48), icu (-0.41), n imaging lines (-0.39) |
| 0PU43JZ | SUPPLEMENT THORACIC VERTEBRA WITH SYNTHETIC SUBSTITUTE, PERCUTANEOUS APPROACH | -0.941 | 945 | n imaging lines (+0.48), transfusion (-0.29), multiple or days (-0.25) |
| 8E0ZXY6 | ISOLATION | -0.948 | 913 | n j code lines (-0.27), multiple or days (-0.23), work rvu (-0.23) |
| 0QSH04Z | REPOSITION LEFT TIBIA WITH INTERNAL FIXATION DEVICE, OPEN APPROACH | -0.972 | 581 | transfusion (-0.26), icu (-0.25), relative claim charge (-0.24) |
| 0QSG04Z | REPOSITION RIGHT TIBIA WITH INTERNAL FIXATION DEVICE, OPEN APPROACH | -0.990 | 729 | relative claim charge (-0.26), icu (-0.23), multiple or days (+0.22) |
Tier 3 (n=43 codes)
| code | Description | Score | N claims | Key drivers |
|---|---|---|---|---|
| 5A1223Z | PERFORMANCE OF CARDIAC PACING, CONTINUOUS | 1.105 | 839 | icu (+0.43), relative claim charge (+0.26), work rvu (+0.22) |
| 0DB68ZX | EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC | 0.991 | 1972 | transfusion (+0.40), n distinct rev codes (+0.34), length of stay (+0.21) |
| 0QS706Z | REPOSITION LEFT UPPER FEMUR WITH INTRAMEDULLARY INTERNAL FIXATION DEVICE, OPEN APPROACH | 0.984 | 548 | multiple or days (+0.85), icu (-0.36), organ system count (+0.31) |
| 5A09457 | ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE | 0.970 | 736 | relative claim charge (+0.26), n distinct rev codes (+0.23), icu (+0.19) |
| 3E03317 | INTRODUCTION OF OTHER THROMBOLYTIC INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH | 0.911 | 711 | n imaging lines (+0.41), icu (+0.36), n distinct rev codes (+0.26) |
| 4A023N8 | MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, BILATERAL, PERCUTANEOUS APPROACH | 0.883 | 1324 | relative claim charge (+0.35), n distinct rev codes (+0.28), icu (+0.21) |
| 05HC33Z | INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH | 0.867 | 517 | length of stay (+0.42), multiple or days (+0.41), work rvu (-0.21) |
| 0CJS8ZZ | INSPECTION OF LARYNX, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC | 0.674 | 1053 | mechanical ventilation (+0.24), length of stay (+0.20), relative claim charge (+0.18) |
| 0QB10ZZ | EXCISION OF SACRUM, OPEN APPROACH | 0.653 | 804 | length of stay (+0.66), organ system count (+0.41), transfusion (+0.19) |
| 5A1D70Z | PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY | 0.637 | 9561 | dialysis (+0.60), organ system count (+0.24), n j code lines (-0.14) |
Tier 4 (n=47 codes)
| code | Description | Score | N claims | Key drivers |
|---|---|---|---|---|
| 3E033XZ | INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH | 3.271 | 2045 | n j code lines (+0.57), icu (+0.42), multiple or days (+0.35) |
| 5A0935A | ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY | 3.176 | 1226 | n j code lines (+0.66), multiple or days (+0.58), icu (+0.37) |
| 02RF08Z | REPLACEMENT OF AORTIC VALVE WITH ZOOPLASTIC TISSUE, OPEN APPROACH | 3.154 | 540 | multiple or days (+0.87), work rvu (+0.69), n j code lines (+0.56) |
| 30233R1 | TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH | 3.022 | 1351 | transfusion (+0.99), n distinct rev codes (+0.32), n j code lines (+0.31) |
| 5A12012 | PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL | 3.018 | 1059 | mechanical ventilation (+0.61), icu (+0.42), n distinct rev codes (+0.37) |
| 0D1B0Z4 | BYPASS ILEUM TO CUTANEOUS, OPEN APPROACH | 3.009 | 660 | relative claim charge (+0.96), transfusion (+0.43), n j code lines (+0.40) |
| 3E0G76Z | INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING | 3.001 | 2293 | length of stay (+0.58), n j code lines (+0.42), mechanical ventilation (+0.35) |
| 30233K1 | TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH | 2.957 | 1347 | transfusion (+0.98), n distinct rev codes (+0.34), icu (+0.30) |
| 0DH63UZ | INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH | 2.838 | 1743 | length of stay (+0.79), n distinct rev codes (+0.45), relative claim charge (+0.44) |
| B31R1ZZ | FLUOROSCOPY OF INTRACRANIAL ARTERIES USING LOW OSMOLAR CONTRAST | 2.657 | 534 | multiple or days (+0.61), n imaging lines (+0.53), icu (+0.52) |
Tier 5 (n=15 codes)
| code | Description | Score | N claims | Key drivers |
|---|---|---|---|---|
| 5A1D90Z | PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY | 7.129 | 627 | n distinct rev codes (+0.86), relative claim charge (+0.78), n j code lines (+0.77) |
| 0B9F8ZX | DRAINAGE OF RIGHT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC | 5.648 | 509 | n j code lines (+0.95), relative claim charge (+0.77), mechanical ventilation (+0.62) |
| 3E043XZ | INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH | 5.385 | 1345 | n j code lines (+0.64), multiple or days (+0.61), icu (+0.52) |
| 5A1955Z | RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS | 5.179 | 4214 | mechanical ventilation (+1.29), relative claim charge (+0.92), length of stay (+0.79) |
| 04HY32Z | INSERTION OF MONITORING DEVICE INTO LOWER ARTERY, PERCUTANEOUS APPROACH | 4.923 | 555 | relative claim charge (+0.97), n j code lines (+0.72), mechanical ventilation (+0.64) |
| 4A133J1 | MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH | 4.637 | 1005 | n j code lines (+0.91), multiple or days (+0.50), work rvu (+0.42) |
| 4A10X4Z | MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH | 4.487 | 1233 | n imaging lines (+0.69), n j code lines (+0.66), n distinct rev codes (+0.56) |
| 4A133B1 | MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH | 4.423 | 1388 | n j code lines (+0.82), multiple or days (+0.51), work rvu (+0.49) |
| 03HY32Z | INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH | 4.170 | 3374 | n j code lines (+0.66), multiple or days (+0.47), icu (+0.43) |
| 0DH67UZ | INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING | 4.151 | 764 | n j code lines (+0.63), length of stay (+0.51), n distinct rev codes (+0.48) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n distinct rev codes | 72 | 40.400 |
| icu | 70 | 39.300 |
| n j code lines | 65 | 36.500 |
| relative claim charge | 61 | 34.300 |
| multiple or days | 56 | 31.500 |
| transfusion | 55 | 30.900 |
| length of stay | 46 | 25.800 |
| n imaging lines | 31 | 17.400 |
| work rvu | 25 | 14.000 |
| organ system count | 23 | 12.900 |
| mechanical ventilation | 15 | 8.400 |
| dialysis | 9 | 5.100 |
| or | 5 | 2.800 |
| n distinct hcps | 1 | 0.600 |
