IP - GI.1.hemorrhage

CM Codes

Data Overview

12179 total codes in komodo_rii; 460 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	285
CC	118
MCC	57

PCA Analysis

PC1 explains 42.2% of variance; PC1+PC2 together explain 54.7%.

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	icu	work rvu	n j code lines
1	314.000	2610635.000	16.846	4.869	1.011	0.756	5.929	0.339	0.399	0.327
2	127.000	680129.000	18.545	6.377	1.294	0.824	5.944	0.420	0.474	0.419
3	19.000	64660.000	21.687	8.866	1.921	1.157	6.229	0.595	0.651	0.542

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	59	54	5	118
MCC	19	25	13	57
No CC/MCC	236	48	1	285
All	314	127	19	460

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.391	-0.109	0.475
avg_n_distinct_rev_codes	0.383	-0.059	0.352
avg_length_of_stay	0.350	-0.148	0.395
rate_icu	0.350	0.000	0.387
rate_mechanical_ventilation	0.330	-0.038	0.466
rate_or	0.312	-0.017	0.300
rate_transfusion	0.229	0.136	0.267
avg_n_imaging_lines	0.222	-0.272	0.241
avg_n_j_code_lines	0.206	-0.035	0.218
rate_multiple_or_days	0.204	0.087	0.249
avg_work_rvu	0.160	-0.073	0.074
rate_dialysis	0.112	0.103	0.291
avg_organ_system_count	0.047	-0.066	-0.350
avg_n_distinct_hcps	-0.153	-0.024	-0.615

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	9.308	3	2997	relative claim charge (+1.48), n distinct rev codes (+1.30), length of stay (+1.27)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K2921	Alcoholic gastritis with bleeding	MCC	-3.264	1	1812	transfusion (-0.92), n distinct rev codes (-0.69), relative claim charge (-0.50)
K5733	Diverticulitis of large intestine without perforation or abscess with bleeding	MCC	-3.257	1	9490	n distinct rev codes (-0.77), or (-0.75), transfusion (-0.59)
K5793	Diverticulitis of intestine, part unspecified, without perforation or abscess with bleeding	MCC	-3.235	1	833	or (-0.82), n distinct rev codes (-0.79), transfusion (-0.63)
K5721	Diverticulitis of large intestine with perforation and abscess with bleeding	MCC	-3.112	1	1748	transfusion (-1.11), n distinct rev codes (-1.10), icu (-0.96)
K5791	Diverticulosis of intestine, part unspecified, without perforation or abscess with bleeding	MCC	-2.543	1	6563	n distinct rev codes (-0.65), or (-0.58), relative claim charge (-0.43)

Top Codes by Tier

Tier 1 (n=314 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C7931	Secondary malignant neoplasm of brain	CC	0.237	797	n imaging lines (+0.46), icu (-0.14), work rvu (-0.12)
I8510	Secondary esophageal varices without bleeding	CC	0.209	6297	or (+0.62), length of stay (-0.33), n j code lines (+0.30)
K7460	Unspecified cirrhosis of liver	No CC/MCC	0.199	9857	or (+0.27), multiple or days (+0.19), length of stay (-0.17)
I248	None	CC	0.192	2799	transfusion (+0.41), icu (+0.35), n distinct rev codes (+0.30)
K633	Ulcer of intestine	CC	0.191	2850	or (+0.29), mechanical ventilation (-0.13), icu (-0.10)
E878	Other disorders of electrolyte and fluid balance, not elsewhere classified	No CC/MCC	0.171	2164	icu (+0.29), n distinct hcps (-0.28), multiple or days (-0.18)
C3490	Malignant neoplasm of unspecified part of unspecified bronchus or lung	CC	0.145	1412	transfusion (+0.23), multiple or days (-0.21), n j code lines (-0.20)
I071	Rheumatic tricuspid insufficiency	No CC/MCC	0.114	1531	n distinct rev codes (+0.25), n distinct hcps (-0.21), work rvu (-0.19)
K269	Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation	No CC/MCC	0.073	3386	work rvu (+0.37), relative claim charge (-0.13), or (+0.12)
U071	COVID-19	MCC	0.071	4907	length of stay (+0.36), relative claim charge (+0.28), or (-0.27)

Tier 2 (n=127 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E873	Alkalosis	CC	4.862	1771	relative claim charge (+0.89), n distinct rev codes (+0.79), length of stay (+0.77)
J159	Unspecified bacterial pneumonia	MCC	4.822	801	relative claim charge (+0.94), n distinct rev codes (+0.76), length of stay (+0.76)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	4.788	2514	or (+0.87), relative claim charge (+0.84), n distinct rev codes (+0.56)
K7682	Hepatic encephalopathy	No CC/MCC	4.570	3411	or (+0.90), icu (+0.60), n distinct rev codes (+0.48)
J90	Pleural effusion, not elsewhere classified	CC	4.507	5848	or (+0.80), n distinct rev codes (+0.73), relative claim charge (+0.64)
L89154	Pressure ulcer of sacral region, stage 4	MCC	4.453	832	length of stay (+0.87), mechanical ventilation (+0.82), relative claim charge (+0.71)
F05	Delirium due to known physiological condition	CC	4.423	2958	length of stay (+0.96), relative claim charge (+0.76), n distinct rev codes (+0.56)
M6281	Muscle weakness (generalized)	No CC/MCC	4.101	1024	length of stay (+2.46), n distinct rev codes (+1.38), work rvu (+0.22)
E870	Hyperosmolality and hypernatremia	CC	4.062	7958	relative claim charge (+0.71), length of stay (+0.68), n distinct rev codes (+0.64)
J189	Pneumonia, unspecified organism	MCC	4.054	9624	n distinct rev codes (+0.71), relative claim charge (+0.68), length of stay (+0.53)

Tier 3 (n=19 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	13.455	1233	mechanical ventilation (+2.74), relative claim charge (+2.24), icu (+1.70)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	11.698	1073	mechanical ventilation (+3.95), icu (+1.60), or (+1.40)
K7200	Acute and subacute hepatic failure without coma	MCC	10.417	1140	mechanical ventilation (+2.10), relative claim charge (+1.85), icu (+1.63)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	9.767	1792	relative claim charge (+1.97), length of stay (+1.35), icu (+1.33)
A419	Sepsis, unspecified organism	MCC	9.678	4128	relative claim charge (+1.59), mechanical ventilation (+1.26), n distinct rev codes (+1.25)
G928	Other toxic encephalopathy	No CC/MCC	9.308	2997	relative claim charge (+1.48), n distinct rev codes (+1.30), length of stay (+1.27)
E874	Mixed disorder of acid-base balance	CC	8.857	1015	relative claim charge (+1.33), mechanical ventilation (+1.27), n distinct rev codes (+1.17)
J690	Pneumonitis due to inhalation of food and vomit	MCC	8.658	5235	mechanical ventilation (+1.46), relative claim charge (+1.41), n distinct rev codes (+1.13)
I639	Cerebral infarction, unspecified	MCC	8.236	735	n imaging lines (+1.91), n distinct rev codes (+1.30), length of stay (+1.20)
J918	Pleural effusion in other conditions classified elsewhere	CC	7.225	916	or (+2.13), relative claim charge (+1.31), n distinct rev codes (+1.29)

Key Driver Frequency

feature	count	pct
relative claim charge	213	46.300
n distinct rev codes	192	41.700
icu	171	37.200
length of stay	167	36.300
or	130	28.300
transfusion	101	22.000
n j code lines	95	20.700
n imaging lines	91	19.800
multiple or days	86	18.700
n distinct hcps	53	11.500
work rvu	48	10.400
mechanical ventilation	25	5.400
dialysis	8	1.700

PCS Codes

Data Overview

2621 total codes in komodo_rii; 80 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 55.0% of variance; PC1+PC2 together explain 64.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	mechanical ventilation	n imaging lines	icu	work rvu
1	46.000	543473.000	17.831	5.226	1.170	5.333	0.015	0.739	0.352	0.333
2	26.000	49884.000	21.535	7.952	1.995	5.724	0.142	1.019	0.611	0.456
3	8.000	12401.000	24.522	11.126	2.868	6.176	0.507	1.209	0.811	0.740

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.350	-0.352
avg_n_distinct_rev_codes	0.342	-0.348
avg_length_of_stay	0.324	-0.394
rate_icu	0.324	-0.295
avg_n_imaging_lines	0.320	-0.427
avg_organ_system_count	0.314	-0.263
rate_transfusion	0.259	-0.096
avg_work_rvu	0.256	-0.037
rate_or	0.256	-0.315
rate_mechanical_ventilation	0.251	-0.339
avg_n_j_code_lines	0.221	-0.211
rate_multiple_or_days	0.153	-0.002
rate_dialysis	0.127	-0.114
avg_n_distinct_hcps	0.019	0.003

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=46 codes)

code	Description	Score	N claims	Key drivers
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.300	17173	dialysis (+0.67), n imaging lines (-0.35), organ system count (+0.28)
XW0G886	INTRODUCTION OF MINERAL-BASED TOPICAL HEMOSTATIC AGENT INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, NEW TECHNOLOGY GROUP 6	-0.328	3520	transfusion (+0.17), length of stay (-0.16), organ system count (-0.11)
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	-0.653	887	or (-0.26), length of stay (+0.22), icu (-0.22)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-0.663	1419	multiple or days (-0.31), or (-0.21), organ system count (+0.15)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-0.665	834	n distinct rev codes (-0.28), organ system count (+0.26), transfusion (-0.19)
3E1M39Z	IRRIGATION OF PERITONEAL CAVITY USING DIALYSATE, PERCUTANEOUS APPROACH	-1.051	963	dialysis (+0.49), n imaging lines (-0.42), or (-0.23)
0DJ07ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-1.136	6171	n imaging lines (-0.45), icu (-0.30), work rvu (+0.25)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.277	109298	transfusion (+0.44), n distinct rev codes (-0.27), relative claim charge (-0.26)
0D598ZZ	DESTRUCTION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-1.296	2070	n imaging lines (-0.35), relative claim charge (-0.23), icu (-0.22)
3E0G8GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-1.340	9798	length of stay (-0.23), n imaging lines (-0.19), n distinct rev codes (-0.18)

Tier 2 (n=26 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.717	7803	n distinct rev codes (+0.44), relative claim charge (+0.42), icu (+0.41)
5A12012	PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL	3.364	729	n imaging lines (+0.64), mechanical ventilation (+0.52), icu (+0.47)
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	3.165	709	icu (+0.58), relative claim charge (+0.54), n imaging lines (+0.44)
B548ZZA	ULTRASONOGRAPHY OF SUPERIOR VENA CAVA, GUIDANCE	3.045	937	n distinct rev codes (+0.43), organ system count (+0.39), length of stay (+0.39)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	2.944	1920	mechanical ventilation (+1.02), icu (+0.64), organ system count (+0.33)
07DR3ZX	EXTRACTION OF ILIAC BONE MARROW, PERCUTANEOUS APPROACH, DIAGNOSTIC	2.922	716	n imaging lines (+0.89), or (+0.52), n distinct rev codes (+0.51)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	2.921	846	n distinct rev codes (+0.66), length of stay (+0.58), or (+0.52)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	2.488	778	relative claim charge (+0.43), organ system count (+0.42), length of stay (+0.41)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	2.352	1359	n distinct rev codes (+0.55), or (+0.50), organ system count (+0.44)
B4141ZZ	FLUOROSCOPY OF SUPERIOR MESENTERIC ARTERY USING LOW OSMOLAR CONTRAST	2.286	1915	or (+0.60), work rvu (+0.51), relative claim charge (+0.36)

Tier 3 (n=8 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	9.029	992	relative claim charge (+1.49), length of stay (+1.23), mechanical ventilation (+1.02)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	6.257	836	length of stay (+1.13), n distinct rev codes (+0.87), relative claim charge (+0.82)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	5.827	2237	mechanical ventilation (+1.02), icu (+0.73), organ system count (+0.69)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	5.601	1173	work rvu (+1.08), icu (+0.74), n distinct rev codes (+0.53)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	5.551	711	n j code lines (+0.80), icu (+0.70), n imaging lines (+0.60)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	5.381	3972	mechanical ventilation (+0.89), icu (+0.66), relative claim charge (+0.65)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	5.178	1731	icu (+0.67), n distinct rev codes (+0.58), relative claim charge (+0.58)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	4.264	749	length of stay (+0.67), n distinct rev codes (+0.66), or (+0.52)

Key Driver Frequency

feature	count	pct
icu	40	50.000
relative claim charge	30	37.500
organ system count	29	36.200
n distinct rev codes	26	32.500
n imaging lines	25	31.200
transfusion	21	26.200
length of stay	18	22.500
work rvu	16	20.000
or	14	17.500
n j code lines	8	10.000
multiple or days	6	7.500
mechanical ventilation	5	6.200
dialysis	2	2.500