IP - ID.1.general_surg

CM Codes

Data Overview

15889 total codes in komodo_rii; 612 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	278
CC	217
MCC	117

PCA Analysis

PC1 explains 47.6% of variance; PC1+PC2 together explain 59.8%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	n imaging lines	work rvu	n j code lines	icu	transfusion
1	270.000	1563330.000	10.375	21.954	0.858	1.226	0.603	0.676	0.409	0.203
2	222.000	986280.000	13.988	24.487	1.166	1.419	0.880	0.796	0.577	0.355
3	120.000	534886.000	17.871	27.134	1.638	1.733	1.086	1.005	0.723	0.505

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	87	85	45	217
MCC	7	47	63	117
No CC/MCC	176	90	12	278
All	270	222	120	612

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.369	-0.030	0.523
avg_n_distinct_rev_codes	0.363	-0.024	0.417
rate_icu	0.349	-0.016	0.422
avg_length_of_stay	0.348	-0.055	0.497
rate_transfusion	0.346	-0.056	0.480
rate_mechanical_ventilation	0.322	-0.014	0.388
avg_n_imaging_lines	0.287	-0.115	0.378
rate_multiple_or_days	0.225	0.020	0.167
rate_dialysis	0.209	0.102	0.410
avg_work_rvu	0.197	0.042	0.125
avg_n_j_code_lines	0.190	0.011	0.220
avg_organ_system_count	0.037	-0.044	-0.543
avg_n_distinct_hcps	-0.075	-0.143	-0.560
rate_or	-0.085	-0.023	-0.149

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
K683	Retroperitoneal hematoma	No CC/MCC	7.471	3	658	transfusion (+1.26), relative claim charge (+1.07), n distinct rev codes (+0.82)
J1569	Pneumonia due to other Gram-negative bacteria	No CC/MCC	5.209	3	1512	relative claim charge (+0.81), mechanical ventilation (+0.67), n distinct rev codes (+0.50)
K7682	Hepatic encephalopathy	No CC/MCC	4.559	3	911	transfusion (+0.77), n distinct rev codes (+0.68), mechanical ventilation (+0.61)
G928	Other toxic encephalopathy	No CC/MCC	4.211	3	16202	n imaging lines (+0.65), n distinct rev codes (+0.60), relative claim charge (+0.53)
G9389	Other specified disorders of brain	No CC/MCC	3.365	3	665	n imaging lines (+1.05), mechanical ventilation (+0.49), n distinct rev codes (+0.48)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K3532	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess	MCC	-4.691	1	4192	n distinct rev codes (-0.83), length of stay (-0.74), transfusion (-0.64)
K3533	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess	MCC	-3.979	1	4328	n distinct rev codes (-0.67), transfusion (-0.55), length of stay (-0.55)
K8510	Biliary acute pancreatitis without necrosis or infection	MCC	-3.174	1	3010	length of stay (-0.58), transfusion (-0.54), icu (-0.39)
A4151	Sepsis due to Escherichia coli [E. coli]	MCC	-1.681	1	25800	length of stay (-0.35), transfusion (-0.26), relative claim charge (-0.25)
A419	Sepsis, unspecified organism	MCC	-1.385	1	222327	length of stay (-0.25), n distinct rev codes (-0.22), relative claim charge (-0.18)

Top Codes by Tier

Tier 1 (n=270 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K529	Noninfective gastroenteritis and colitis, unspecified	No CC/MCC	-0.853	3272	length of stay (-0.18), transfusion (-0.12), relative claim charge (-0.10)
I4510	Unspecified right bundle-branch block	No CC/MCC	-0.872	1481	length of stay (-0.31), transfusion (-0.26), relative claim charge (-0.23)
F331	Major depressive disorder, recurrent, moderate	CC	-0.873	1159	n j code lines (-0.20), transfusion (-0.16), icu (-0.15)
M868X8	Other osteomyelitis, other site	CC	-0.895	853	multiple or days (-0.32), n j code lines (-0.27), length of stay (+0.24)
C679	Malignant neoplasm of bladder, unspecified	No CC/MCC	-0.902	960	relative claim charge (-0.25), mechanical ventilation (-0.21), length of stay (-0.18)
K2970	Gastritis, unspecified, without bleeding	No CC/MCC	-0.916	1144	work rvu (-0.20), icu (-0.18), mechanical ventilation (-0.15)
K862	Cyst of pancreas	CC	-0.938	993	mechanical ventilation (-0.22), n imaging lines (+0.22), icu (-0.20)
K521	Toxic gastroenteritis and colitis	CC	-0.952	999	n j code lines (-0.27), icu (-0.20), mechanical ventilation (-0.17)
I7140	Abdominal aortic aneurysm, without rupture, unspecified	No CC/MCC	-0.978	802	length of stay (-0.29), transfusion (-0.27), work rvu (-0.17)
I440	Atrioventricular block, first degree	No CC/MCC	-0.989	646	transfusion (-0.20), length of stay (-0.18), n j code lines (-0.17)

Tier 2 (n=222 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	2.267	7365	or (+0.52), icu (+0.49), relative claim charge (+0.38)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	2.264	4861	icu (+0.39), relative claim charge (+0.37), n distinct rev codes (+0.36)
E162	Hypoglycemia, unspecified	No CC/MCC	2.238	1815	icu (+0.51), mechanical ventilation (+0.46), transfusion (+0.36)
J851	Abscess of lung with pneumonia	MCC	2.216	1398	n distinct rev codes (+0.50), relative claim charge (+0.48), icu (+0.44)
J918	Pleural effusion in other conditions classified elsewhere	CC	2.202	3288	n distinct rev codes (+0.52), icu (+0.45), relative claim charge (+0.42)
K56600	Partial intestinal obstruction, unspecified as to cause	CC	2.184	999	n j code lines (+0.46), length of stay (+0.29), n distinct rev codes (+0.27)
I471	None	CC	2.181	2273	icu (+0.43), n distinct rev codes (+0.39), length of stay (+0.30)
I161	Hypertensive emergency	CC	2.163	1078	icu (+0.39), mechanical ventilation (+0.35), n distinct rev codes (+0.35)
K766	Portal hypertension	CC	2.154	2190	transfusion (+0.51), n distinct rev codes (+0.37), icu (+0.30)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	2.129	7099	dialysis (+1.84), transfusion (+0.30), n j code lines (-0.14)

Tier 3 (n=120 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D65	Disseminated intravascular coagulation [defibrination syndrome]	MCC	8.532	2408	transfusion (+1.24), mechanical ventilation (+1.09), relative claim charge (+1.08)
J95851	Ventilator associated pneumonia	CC	8.386	800	mechanical ventilation (+2.00), length of stay (+1.59), relative claim charge (+1.58)
I6340	Cerebral infarction due to embolism of unspecified cerebral artery	MCC	7.503	699	n imaging lines (+1.92), n distinct rev codes (+1.21), relative claim charge (+1.15)
K683	Retroperitoneal hematoma	No CC/MCC	7.471	658	transfusion (+1.26), relative claim charge (+1.07), n distinct rev codes (+0.82)
I469	Cardiac arrest, cause unspecified	MCC	7.387	1864	mechanical ventilation (+1.64), relative claim charge (+1.16), n distinct rev codes (+0.92)
J80	Acute respiratory distress syndrome	MCC	7.157	2726	mechanical ventilation (+1.55), relative claim charge (+1.34), icu (+0.89)
K767	Hepatorenal syndrome	MCC	6.933	651	transfusion (+1.16), relative claim charge (+0.94), n distinct rev codes (+0.85)
I76	Septic arterial embolism	CC	6.814	1260	n imaging lines (+1.40), n distinct rev codes (+1.08), length of stay (+0.89)
G7281	Critical illness myopathy	CC	6.784	1597	length of stay (+1.26), relative claim charge (+1.13), n distinct rev codes (+0.95)
J15211	Pneumonia due to Methicillin susceptible Staphylococcus aureus	MCC	6.621	898	mechanical ventilation (+1.19), relative claim charge (+0.90), n distinct rev codes (+0.77)

Key Driver Frequency

feature	count	pct
relative claim charge	280	45.800
icu	262	42.800
n distinct rev codes	247	40.400
transfusion	243	39.700
length of stay	237	38.700
mechanical ventilation	146	23.900
multiple or days	110	18.000
n j code lines	98	16.000
n imaging lines	85	13.900
work rvu	71	11.600
dialysis	36	5.900
or	15	2.500
n distinct hcps	6	1.000

PCS Codes

Data Overview

16626 total codes in komodo_rii; 302 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 47.2% of variance; PC1+PC2 together explain 59.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	organ system count	work rvu	n imaging lines	n j code lines	icu
1	102.000	278778.000	11.250	22.907	0.969	6.015	0.511	1.230	0.779	0.422
2	129.000	314591.000	15.621	25.747	1.424	6.348	0.779	1.393	0.937	0.632
3	71.000	242994.000	18.785	28.280	1.788	6.578	1.076	1.775	1.197	0.782

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.356	0.044
avg_relative_claim_charge	0.347	0.037
avg_length_of_stay	0.346	0.056
rate_transfusion	0.333	0.117
rate_icu	0.311	0.114
avg_n_imaging_lines	0.291	0.029
rate_mechanical_ventilation	0.268	0.146
rate_multiple_or_days	0.257	0.057
avg_organ_system_count	0.245	0.087
avg_work_rvu	0.239	0.081
rate_dialysis	0.194	0.094
avg_n_j_code_lines	0.189	-0.051
avg_n_distinct_hcps	0.114	-0.009
rate_or	-0.003	-0.005

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=102 codes)

code	Description	Score	N claims	Key drivers
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	-1.299	2967	n distinct hcps (-0.24), work rvu (-0.20), relative claim charge (-0.17)
0HRNXK3	REPLACEMENT OF LEFT FOOT SKIN WITH NONAUTOLOGOUS TISSUE SUBSTITUTE, FULL THICKNESS, EXTERNAL APPROACH	-1.332	1214	icu (-0.42), mechanical ventilation (-0.24), transfusion (-0.24)
0JH60WZ	INSERTION OF TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-1.389	1573	relative claim charge (-0.27), organ system count (-0.24), multiple or days (-0.20)
3E0T3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	-1.398	3826	relative claim charge (-0.21), length of stay (-0.18), icu (-0.18)
0Y6N0ZB	DETACHMENT AT LEFT FOOT, PARTIAL 2ND RAY, OPEN APPROACH	-1.423	2720	icu (-0.38), n imaging lines (-0.34), relative claim charge (-0.25)
B240ZZ3	ULTRASONOGRAPHY OF SINGLE CORONARY ARTERY, INTRAVASCULAR	-1.428	958	length of stay (-0.44), transfusion (-0.35), multiple or days (-0.32)
B54NZZA	ULTRASONOGRAPHY OF LEFT UPPER EXTREMITY VEINS, GUIDANCE	-1.448	640	work rvu (-0.37), multiple or days (-0.31), relative claim charge (-0.20)
0QBM0ZX	EXCISION OF LEFT TARSAL, OPEN APPROACH, DIAGNOSTIC	-1.454	830	icu (-0.39), work rvu (-0.25), mechanical ventilation (-0.25)
0Y6N0ZC	DETACHMENT AT LEFT FOOT, PARTIAL 3RD RAY, OPEN APPROACH	-1.460	2503	icu (-0.37), n imaging lines (-0.33), relative claim charge (-0.24)
0Y6M0ZD	DETACHMENT AT RIGHT FOOT, PARTIAL 4TH RAY, OPEN APPROACH	-1.475	2769	icu (-0.39), n imaging lines (-0.29), relative claim charge (-0.26)

Tier 2 (n=129 codes)

code	Description	Score	N claims	Key drivers
4A023N6	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, RIGHT HEART, PERCUTANEOUS APPROACH	1.826	896	n distinct rev codes (+0.48), relative claim charge (+0.41), icu (+0.32)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	1.809	6240	mechanical ventilation (+1.37), icu (+0.49), length of stay (-0.30)
0F9430Z	DRAINAGE OF GALLBLADDER WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	1.793	1255	n distinct rev codes (+0.40), n imaging lines (+0.38), length of stay (+0.31)
3E0336Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.760	2357	length of stay (+0.54), relative claim charge (+0.40), n distinct rev codes (+0.32)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.655	3138	n distinct rev codes (+0.46), transfusion (+0.42), n imaging lines (+0.31)
0DTG0ZZ	RESECTION OF LEFT LARGE INTESTINE, OPEN APPROACH	1.635	1079	transfusion (+0.41), icu (+0.39), relative claim charge (+0.34)
0DB60ZZ	EXCISION OF STOMACH, OPEN APPROACH	1.574	736	relative claim charge (+0.54), transfusion (+0.50), icu (+0.46)
0DBB0ZZ	EXCISION OF ILEUM, OPEN APPROACH	1.555	2668	relative claim charge (+0.44), icu (+0.34), transfusion (+0.33)
02HK3NZ	INSERTION OF INTRACARDIAC PACEMAKER INTO RIGHT VENTRICLE, PERCUTANEOUS APPROACH	1.519	648	relative claim charge (+0.73), n distinct rev codes (+0.39), length of stay (+0.29)
0DB98ZX	EXCISION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.485	1184	transfusion (+0.43), n distinct rev codes (+0.37), n imaging lines (+0.25)

Tier 3 (n=71 codes)

code	Description	Score	N claims	Key drivers
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	7.000	3027	dialysis (+1.24), transfusion (+0.76), relative claim charge (+0.72)
5A1221Z	PERFORMANCE OF CARDIAC OUTPUT, CONTINUOUS	6.830	1221	relative claim charge (+1.20), n distinct rev codes (+1.10), transfusion (+0.95)
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	6.227	12554	mechanical ventilation (+1.37), relative claim charge (+0.99), length of stay (+0.76)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	6.203	1409	n imaging lines (+1.37), n distinct rev codes (+0.86), length of stay (+0.66)
07DR3ZX	EXTRACTION OF ILIAC BONE MARROW, PERCUTANEOUS APPROACH, DIAGNOSTIC	5.480	908	multiple or days (+1.45), n imaging lines (+1.00), n distinct rev codes (+0.70)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	5.440	793	work rvu (+1.93), n j code lines (+1.47), multiple or days (+1.28)
30243N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	5.380	1933	transfusion (+1.16), multiple or days (+0.72), length of stay (+0.49)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	5.299	2055	n j code lines (+0.69), length of stay (+0.65), multiple or days (+0.59)
02PYX3Z	REMOVAL OF INFUSION DEVICE FROM GREAT VESSEL, EXTERNAL APPROACH	5.113	1273	length of stay (+0.76), dialysis (+0.70), n distinct rev codes (+0.52)
0W3P8ZZ	CONTROL BLEEDING IN GASTROINTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	5.096	1991	transfusion (+0.90), n distinct rev codes (+0.71), length of stay (+0.51)

Key Driver Frequency

feature	count	pct
relative claim charge	139	46.000
icu	129	42.700
n distinct rev codes	114	37.700
length of stay	107	35.400
transfusion	100	33.100
organ system count	64	21.200
n imaging lines	55	18.200
multiple or days	49	16.200
work rvu	47	15.600
mechanical ventilation	44	14.600
n j code lines	31	10.300
dialysis	15	5.000
n distinct hcps	12	4.000