IP - GI.1.major_procedure

CM Codes

Data Overview

11438 total codes in komodo_rii; 433 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	222
CC	169
MCC	42

PCA Analysis

PC1 explains 53.5% of variance; PC1+PC2 together explain 63.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	relative claim charge	n imaging lines	n j code lines	icu	work rvu
1	202.000	1053075.000	6.916	16.491	4.701	0.963	0.466	0.786	0.173	0.823
2	165.000	676825.000	10.387	20.040	5.139	1.288	0.812	0.877	0.322	0.922
3	66.000	135606.000	15.351	24.055	5.819	1.899	1.132	1.212	0.540	1.139

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	62	80	27	169
MCC	3	14	25	42
No CC/MCC	137	71	14	222
All	202	165	66	433

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.354	-0.095	0.456
avg_length_of_stay	0.346	-0.126	0.450
avg_relative_claim_charge	0.346	-0.120	0.468
rate_icu	0.346	-0.068	0.429
avg_n_imaging_lines	0.333	-0.093	0.459
rate_transfusion	0.325	-0.131	0.451
rate_mechanical_ventilation	0.308	-0.062	0.386
rate_multiple_or_days	0.248	-0.032	0.284
avg_organ_system_count	0.226	-0.079	-0.136
avg_n_j_code_lines	0.176	-0.032	0.339
avg_n_distinct_hcps	0.167	-0.222	-0.030
rate_dialysis	0.124	0.004	0.416
avg_work_rvu	0.104	-0.047	0.128
rate_or	-0.084	-0.084	-0.178

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G928	Other toxic encephalopathy	No CC/MCC	7.510	3	1711	n imaging lines (+1.09), relative claim charge (+1.08), n distinct rev codes (+0.92)
E8729	Other acidosis	No CC/MCC	5.159	3	1069	mechanical ventilation (+0.82), icu (+0.77), n distinct rev codes (+0.64)
E8770	Fluid overload, unspecified	No CC/MCC	4.976	3	1353	n distinct rev codes (+0.56), length of stay (+0.54), icu (+0.53)
D6959	Other secondary thrombocytopenia	No CC/MCC	4.251	3	765	transfusion (+0.74), relative claim charge (+0.56), icu (+0.42)
B952	Enterococcus as the cause of diseases classified elsewhere	No CC/MCC	3.938	3	1193	length of stay (+0.76), multiple or days (+0.56), relative claim charge (+0.52)

Under-tiered: Tier 1, MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K3533	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess	MCC	-1.925	1	2091	organ system count (-0.39), transfusion (-0.37), icu (-0.31)
K3532	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess	MCC	-1.313	1	1613	organ system count (-0.39), transfusion (-0.36), relative claim charge (-0.29)
K5733	Diverticulitis of large intestine without perforation or abscess with bleeding	MCC	-0.876	1	609	organ system count (-0.21), n imaging lines (-0.18), n j code lines (-0.15)

Top Codes by Tier

Tier 1 (n=202 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F329	Major depressive disorder, single episode, unspecified	No CC/MCC	-0.760	2103	transfusion (-0.19), relative claim charge (-0.19), n distinct rev codes (-0.17)
K3184	Gastroparesis	No CC/MCC	-0.774	1003	transfusion (-0.18), icu (-0.17), n imaging lines (-0.12)
K682	Retroperitoneal fibrosis	No CC/MCC	-0.783	821	n j code lines (+0.83), work rvu (+0.47), n distinct hcps (-0.42)
D649	Anemia, unspecified	No CC/MCC	-0.828	17128	relative claim charge (-0.18), icu (-0.14), mechanical ventilation (-0.12)
G894	Chronic pain syndrome	No CC/MCC	-0.843	1414	organ system count (+0.38), relative claim charge (-0.22), transfusion (-0.21)
K611	Rectal abscess	CC	-0.845	1231	relative claim charge (-0.35), icu (-0.32), n j code lines (+0.27)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	-0.848	11884	transfusion (-0.19), relative claim charge (-0.19), mechanical ventilation (-0.17)
I447	Left bundle-branch block, unspecified	No CC/MCC	-0.852	725	multiple or days (-0.31), length of stay (-0.16), n imaging lines (-0.15)
I739	Peripheral vascular disease, unspecified	No CC/MCC	-0.875	3144	relative claim charge (-0.17), n distinct hcps (-0.15), organ system count (+0.14)
K5733	Diverticulitis of large intestine without perforation or abscess with bleeding	MCC	-0.876	609	organ system count (-0.21), n imaging lines (-0.18), n j code lines (-0.15)

Tier 2 (n=165 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E2740	Unspecified adrenocortical insufficiency	CC	2.641	672	n j code lines (+0.53), mechanical ventilation (+0.40), relative claim charge (+0.37)
E875	Hyperkalemia	No CC/MCC	2.624	3735	multiple or days (+0.38), n distinct hcps (+0.31), icu (+0.29)
E43	Unspecified severe protein-calorie malnutrition	MCC	2.609	19031	length of stay (+0.50), n distinct rev codes (+0.39), n imaging lines (+0.37)
K55029	Acute infarction of small intestine, extent unspecified	MCC	2.515	3531	mechanical ventilation (+0.51), icu (+0.49), n imaging lines (+0.42)
E8720	Acidosis, unspecified	No CC/MCC	2.477	16313	icu (+0.46), n distinct rev codes (+0.39), n imaging lines (+0.34)
I9589	Other hypotension	No CC/MCC	2.456	766	icu (+0.51), transfusion (+0.48), n distinct rev codes (+0.30)
I471	None	CC	2.447	1260	icu (+0.52), n distinct hcps (+0.40), n distinct rev codes (+0.35)
K658	Other peritonitis	MCC	2.389	4180	icu (+0.39), relative claim charge (+0.36), n distinct rev codes (+0.36)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	2.380	1325	dialysis (+1.23), transfusion (+0.36), n distinct hcps (-0.26)
K631	Perforation of intestine (nontraumatic)	MCC	2.343	12774	n imaging lines (+0.44), icu (+0.42), n distinct rev codes (+0.36)

Tier 3 (n=66 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K7200	Acute and subacute hepatic failure without coma	MCC	10.968	775	mechanical ventilation (+2.03), relative claim charge (+1.41), transfusion (+1.29)
J9602	Acute respiratory failure with hypercapnia	MCC	8.614	1500	mechanical ventilation (+1.78), icu (+1.27), relative claim charge (+1.23)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	8.553	1275	mechanical ventilation (+1.84), icu (+1.19), transfusion (+0.89)
E874	Mixed disorder of acid-base balance	CC	8.373	963	mechanical ventilation (+1.41), relative claim charge (+1.15), icu (+1.08)
T8144XA	Sepsis following a procedure, initial encounter	CC	8.270	750	length of stay (+1.17), relative claim charge (+1.14), icu (+1.04)
J95821	Acute postprocedural respiratory failure	MCC	7.786	1690	mechanical ventilation (+1.84), icu (+1.20), relative claim charge (+0.94)
A419	Sepsis, unspecified organism	MCC	7.675	10595	mechanical ventilation (+1.09), icu (+1.02), relative claim charge (+0.99)
G9340	Encephalopathy, unspecified	CC	7.557	1097	n imaging lines (+1.01), n distinct rev codes (+0.94), length of stay (+0.91)
G928	Other toxic encephalopathy	No CC/MCC	7.510	1711	n imaging lines (+1.09), relative claim charge (+1.08), n distinct rev codes (+0.92)
G9341	Metabolic encephalopathy	MCC	7.123	4022	n imaging lines (+1.02), relative claim charge (+0.92), icu (+0.91)

Key Driver Frequency

feature	count	pct
n distinct rev codes	210	48.500
n imaging lines	189	43.600
length of stay	167	38.600
icu	146	33.700
transfusion	126	29.100
relative claim charge	122	28.200
organ system count	98	22.600
multiple or days	78	18.000
n distinct hcps	57	13.200
n j code lines	42	9.700
mechanical ventilation	41	9.500
work rvu	13	3.000
or	5	1.200
dialysis	5	1.200

PCS Codes

Data Overview

7493 total codes in komodo_rii; 219 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 58.2% of variance; PC1+PC2 together explain 70.3%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	relative claim charge	n imaging lines	n j code lines	icu	work rvu
1	91.000	500876.000	6.543	16.212	4.069	1.016	0.408	0.845	0.156	0.757
2	91.000	259480.000	11.014	20.676	4.697	1.393	0.827	1.123	0.334	0.969
3	37.000	92422.000	16.837	25.448	5.497	2.129	1.183	1.494	0.592	1.162

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.342	-0.137
avg_relative_claim_charge	0.332	-0.101
avg_length_of_stay	0.331	-0.103
rate_icu	0.331	-0.105
avg_organ_system_count	0.328	-0.154
avg_n_imaging_lines	0.313	-0.133
rate_transfusion	0.306	-0.140
avg_n_distinct_hcps	0.279	-0.129
rate_multiple_or_days	0.246	0.009
rate_mechanical_ventilation	0.230	-0.024
avg_n_j_code_lines	0.180	-0.001
rate_dialysis	0.134	0.031
avg_work_rvu	0.111	-0.034
rate_or	0.011	-0.059

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=91 codes)

code	Description	Score	N claims	Key drivers
0DBM0ZZ	EXCISION OF DESCENDING COLON, OPEN APPROACH	-1.094	4443	n imaging lines (-0.14), n distinct rev codes (-0.14), organ system count (-0.13)
0W9G4ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS ENDOSCOPIC APPROACH	-1.124	906	organ system count (-0.24), n j code lines (+0.23), transfusion (-0.23)
0DJD4ZZ	INSPECTION OF LOWER INTESTINAL TRACT, PERCUTANEOUS ENDOSCOPIC APPROACH	-1.127	7256	transfusion (-0.16), relative claim charge (-0.15), icu (-0.15)
0WQF0ZZ	REPAIR ABDOMINAL WALL, OPEN APPROACH	-1.135	15691	transfusion (-0.17), relative claim charge (-0.17), n distinct rev codes (-0.13)
0DTF0ZZ	RESECTION OF RIGHT LARGE INTESTINE, OPEN APPROACH	-1.167	21620	n distinct hcps (-0.41), relative claim charge (-0.16), n j code lines (-0.13)
07BB0ZX	EXCISION OF MESENTERIC LYMPHATIC, OPEN APPROACH, DIAGNOSTIC	-1.211	600	multiple or days (-0.29), relative claim charge (-0.23), n j code lines (-0.18)
0DBP0ZZ	EXCISION OF RECTUM, OPEN APPROACH	-1.257	7976	n imaging lines (-0.23), n distinct rev codes (-0.16), length of stay (-0.14)
0D1E4Z4	BYPASS LARGE INTESTINE TO CUTANEOUS, PERCUTANEOUS ENDOSCOPIC APPROACH	-1.271	1091	icu (-0.25), transfusion (-0.17), length of stay (-0.16)
0DTN0ZZ	RESECTION OF SIGMOID COLON, OPEN APPROACH	-1.272	21067	n distinct hcps (-0.23), transfusion (-0.17), relative claim charge (-0.14)
0DTK0ZZ	RESECTION OF ASCENDING COLON, OPEN APPROACH	-1.272	1150	n distinct hcps (-0.50), n distinct rev codes (-0.15), relative claim charge (-0.15)

Tier 2 (n=91 codes)

code	Description	Score	N claims	Key drivers
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.647	2177	transfusion (+0.55), n imaging lines (+0.52), n distinct rev codes (+0.43)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.499	1073	transfusion (+0.56), n imaging lines (+0.54), n distinct rev codes (+0.45)
3E0336Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.485	5210	length of stay (+0.47), n distinct hcps (+0.45), n distinct rev codes (+0.35)
0WJG0ZZ	INSPECTION OF PERITONEAL CAVITY, OPEN APPROACH	2.304	1313	icu (+0.43), relative claim charge (+0.41), n distinct rev codes (+0.32)
0DB98ZX	EXCISION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.248	1403	transfusion (+0.59), n imaging lines (+0.51), n distinct rev codes (+0.39)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	2.195	2001	length of stay (+0.37), n j code lines (+0.34), multiple or days (+0.34)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.146	2401	icu (+0.51), organ system count (+0.43), n distinct rev codes (+0.27)
0DJD0ZZ	INSPECTION OF LOWER INTESTINAL TRACT, OPEN APPROACH	2.030	1037	icu (+0.39), relative claim charge (+0.32), n imaging lines (+0.31)
0FT40ZZ	RESECTION OF GALLBLADDER, OPEN APPROACH	1.829	2018	icu (+0.35), relative claim charge (+0.34), n distinct hcps (+0.23)
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	1.747	889	multiple or days (+0.34), organ system count (+0.33), n distinct rev codes (+0.30)

Tier 3 (n=37 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	10.221	1733	relative claim charge (+1.73), mechanical ventilation (+1.58), icu (+1.01)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	7.683	1285	n distinct hcps (+1.06), icu (+1.05), organ system count (+0.98)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	7.355	2817	mechanical ventilation (+1.58), icu (+1.11), organ system count (+0.81)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	7.232	3823	mechanical ventilation (+1.33), icu (+0.98), relative claim charge (+0.87)
30243N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	6.981	797	transfusion (+1.22), multiple or days (+0.75), n distinct rev codes (+0.66)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	6.242	1772	mechanical ventilation (+1.58), icu (+0.94), organ system count (+0.62)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	6.043	678	length of stay (+0.89), n distinct rev codes (+0.89), organ system count (+0.78)
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	5.780	1318	transfusion (+1.19), icu (+0.80), n distinct hcps (+0.76)
0W9G30Z	DRAINAGE OF PERITONEAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	5.762	2902	length of stay (+0.95), relative claim charge (+0.78), n imaging lines (+0.59)
0JQ80ZZ	REPAIR ABDOMEN SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	5.686	684	multiple or days (+1.22), relative claim charge (+0.80), length of stay (+0.63)

Key Driver Frequency

feature	count	pct
n distinct rev codes	102	46.600
n imaging lines	94	42.900
organ system count	69	31.500
n distinct hcps	65	29.700
relative claim charge	63	28.800
icu	62	28.300
length of stay	58	26.500
multiple or days	45	20.500
transfusion	44	20.100
n j code lines	40	18.300
work rvu	10	4.600
mechanical ventilation	4	1.800
dialysis	1	0.500