IP - ME.1.misc_disorder

CM Codes

Data Overview

17258 total codes in komodo_rii; 507 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	343
CC	130
MCC	34

PCA Analysis

PC1 explains 34.5% of variance; PC1+PC2 together explain 49.0%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	work rvu	relative claim charge	n j code lines	n imaging lines	icu
1	54.000	277966.000	11.976	5.052	4.688	0.557	0.920	0.451	0.493	0.194
2	311.000	3119405.000	14.856	5.799	5.722	0.733	1.060	0.511	0.854	0.291
3	126.000	437608.000	16.367	7.225	5.825	0.946	1.317	0.744	1.005	0.320
4	16.000	42977.000	18.490	8.745	5.839	1.574	1.747	1.173	1.186	0.449

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	11	67	48	4	130
MCC	0	5	18	11	34
No CC/MCC	43	239	60	1	343
All	54	311	126	16	507

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.397	-0.127	0.420
avg_n_distinct_rev_codes	0.390	-0.065	0.336
rate_multiple_or_days	0.296	-0.065	0.234
avg_length_of_stay	0.292	-0.194	0.299
rate_transfusion	0.292	0.104	0.417
rate_mechanical_ventilation	0.282	0.103	0.484
avg_n_j_code_lines	0.280	-0.136	0.192
rate_icu	0.253	0.268	0.316
avg_n_imaging_lines	0.242	-0.073	0.083
avg_work_rvu	0.234	-0.225	0.105
rate_or	0.207	-0.104	0.166
avg_organ_system_count	0.189	-0.083	-0.239
avg_n_distinct_hcps	0.105	-0.036	-0.172
rate_dialysis	0.082	0.185	0.147

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (1 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K7682	Hepatic encephalopathy	No CC/MCC	4.720	4	2391	n j code lines (+0.89), multiple or days (+0.64), relative claim charge (+0.61)

Under-tiered: Tier 1, MCC (0 codes)

None.

Top Codes by Tier

Tier 1 (n=54 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M62838	Other muscle spasm	No CC/MCC	-1.991	884	relative claim charge (-0.39), multiple or days (-0.30), n distinct rev codes (-0.26)
J4540	Moderate persistent asthma, uncomplicated	No CC/MCC	-2.016	1215	n distinct rev codes (-0.35), relative claim charge (-0.34), length of stay (-0.27)
K529	Noninfective gastroenteritis and colitis, unspecified	No CC/MCC	-2.043	12378	relative claim charge (-0.41), length of stay (-0.36), n distinct rev codes (-0.29)
E063	Autoimmune thyroiditis	No CC/MCC	-2.111	1275	n distinct rev codes (-0.50), length of stay (-0.24), icu (-0.21)
E7849	Other hyperlipidemia	No CC/MCC	-2.127	1329	n j code lines (-0.37), relative claim charge (-0.31), multiple or days (-0.30)
E282	Polycystic ovarian syndrome	No CC/MCC	-2.142	1126	or (+1.42), n distinct rev codes (-1.01), length of stay (-0.71)
F410	Panic disorder [episodic paroxysmal anxiety]	No CC/MCC	-2.186	2359	n distinct rev codes (-0.52), relative claim charge (-0.35), multiple or days (-0.26)
E66811	Obesity, class 1	No CC/MCC	-2.193	1598	n distinct rev codes (-0.39), relative claim charge (-0.34), length of stay (-0.31)
F332	Major depressive disorder, recurrent severe without psychotic features	CC	-2.206	1843	n distinct rev codes (-0.66), length of stay (+0.42), icu (-0.28)
E890	Postprocedural hypothyroidism	No CC/MCC	-2.235	5393	relative claim charge (-0.46), n distinct rev codes (-0.29), length of stay (-0.29)

Tier 2 (n=311 codes)

code	Description	CMS severity	Score	N claims	Key drivers
L03116	Cellulitis of left lower limb	CC	0.711	2835	length of stay (+0.26), n distinct rev codes (+0.25), organ system count (+0.18)
E43	Unspecified severe protein-calorie malnutrition	MCC	0.689	67542	length of stay (+0.48), relative claim charge (+0.39), organ system count (-0.20)
E806	Other disorders of bilirubin metabolism	No CC/MCC	0.660	1355	n j code lines (+0.60), work rvu (+0.59), multiple or days (+0.54)
I081	Rheumatic disorders of both mitral and tricuspid valves	No CC/MCC	0.650	1651	n distinct rev codes (+0.34), multiple or days (-0.30), icu (+0.27)
I248	None	CC	0.646	2418	n distinct rev codes (+0.30), icu (+0.28), n distinct hcps (+0.19)
N12	Tubulo-interstitial nephritis, not specified as acute or chronic	CC	0.643	939	n j code lines (+0.79), work rvu (+0.30), mechanical ventilation (-0.12)
L299	Pruritus, unspecified	No CC/MCC	0.642	1007	organ system count (+0.42), n distinct hcps (+0.23), n j code lines (+0.21)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	0.620	7340	icu (+0.27), n distinct rev codes (+0.22), multiple or days (-0.16)
M48061	Spinal stenosis, lumbar region without neurogenic claudication	No CC/MCC	0.610	2273	n imaging lines (+0.45), n distinct rev codes (+0.37), n j code lines (-0.28)
N3090	Cystitis, unspecified without hematuria	No CC/MCC	0.610	1133	multiple or days (+0.52), n imaging lines (+0.23), work rvu (+0.22)

Tier 3 (n=126 codes)

code	Description	CMS severity	Score	N claims	Key drivers
B3781	Candidal esophagitis	CC	4.275	895	relative claim charge (+0.85), n distinct rev codes (+0.78), multiple or days (+0.69)
E7220	Disorder of urea cycle metabolism, unspecified	CC	4.220	1150	relative claim charge (+1.06), mechanical ventilation (+0.70), n distinct rev codes (+0.63)
I517	Cardiomegaly	No CC/MCC	4.206	994	n j code lines (+1.94), work rvu (+1.63), multiple or days (+1.15)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	4.044	9217	relative claim charge (+0.87), mechanical ventilation (+0.67), icu (+0.67)
G928	Other toxic encephalopathy	No CC/MCC	4.014	10099	relative claim charge (+0.91), n distinct rev codes (+0.74), mechanical ventilation (+0.59)
J9601	Acute respiratory failure with hypoxia	MCC	3.970	26849	mechanical ventilation (+0.89), relative claim charge (+0.73), icu (+0.62)
K567	Ileus, unspecified	CC	3.874	2760	relative claim charge (+1.06), length of stay (+0.70), n j code lines (+0.44)
N170	Acute kidney failure with tubular necrosis	MCC	3.868	7527	relative claim charge (+0.75), n distinct rev codes (+0.55), mechanical ventilation (+0.45)
K7469	Other cirrhosis of liver	No CC/MCC	3.861	970	n j code lines (+1.46), work rvu (+0.48), relative claim charge (+0.47)
G9340	Encephalopathy, unspecified	CC	3.518	7072	n distinct rev codes (+0.58), relative claim charge (+0.52), n imaging lines (+0.48)

Tier 4 (n=16 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K7200	Acute and subacute hepatic failure without coma	MCC	10.329	974	mechanical ventilation (+2.71), relative claim charge (+1.97), n distinct rev codes (+1.13)
J9602	Acute respiratory failure with hypercapnia	MCC	9.872	2583	mechanical ventilation (+2.75), relative claim charge (+1.93), icu (+1.14)
A419	Sepsis, unspecified organism	MCC	9.426	8407	relative claim charge (+1.53), n j code lines (+1.25), multiple or days (+1.13)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.138	6794	relative claim charge (+2.05), mechanical ventilation (+1.55), n distinct rev codes (+1.23)
D62	Acute posthemorrhagic anemia	CC	8.370	6263	transfusion (+2.42), relative claim charge (+1.31), n distinct rev codes (+1.10)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	7.865	1252	mechanical ventilation (+2.57), relative claim charge (+0.95), n j code lines (+0.90)
G936	Cerebral edema	MCC	7.647	907	mechanical ventilation (+1.22), n j code lines (+1.19), relative claim charge (+1.02)
K922	Gastrointestinal hemorrhage, unspecified	CC	6.964	1594	transfusion (+1.62), multiple or days (+1.33), work rvu (+0.89)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	6.955	2807	relative claim charge (+1.60), mechanical ventilation (+1.32), icu (+1.08)
I639	Cerebral infarction, unspecified	MCC	6.258	1361	n distinct rev codes (+1.12), relative claim charge (+1.09), n imaging lines (+1.08)

Key Driver Frequency

feature	count	pct
relative claim charge	262	51.700
n distinct rev codes	243	47.900
length of stay	167	32.900
n j code lines	146	28.800
multiple or days	124	24.500
icu	120	23.700
transfusion	99	19.500
n imaging lines	93	18.300
organ system count	83	16.400
work rvu	73	14.400
or	49	9.700
mechanical ventilation	28	5.500
n distinct hcps	19	3.700
dialysis	15	3.000

PCS Codes

Data Overview

3394 total codes in komodo_rii; 55 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 46.8% of variance; PC1+PC2 together explain 62.7%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	n j code lines	work rvu	n imaging lines	mechanical ventilation
1	8.000	14593.000	11.673	3.347	1.125	2.987	0.469	0.159	0.363	0.018
2	27.000	113661.000	16.770	6.934	1.665	4.820	0.699	0.604	0.890	0.031
3	16.000	47801.000	19.434	8.787	2.168	5.202	1.111	1.031	1.129	0.131
4	4.000	7842.000	22.294	11.782	4.180	5.526	2.001	1.707	1.423	0.831

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.357	0.059
avg_work_rvu	0.341	-0.003
rate_icu	0.332	-0.052
avg_length_of_stay	0.331	0.068
avg_relative_claim_charge	0.331	0.048
avg_n_j_code_lines	0.289	-0.146
avg_organ_system_count	0.274	-0.034
rate_mechanical_ventilation	0.264	-0.026
avg_n_imaging_lines	0.248	-0.217
rate_transfusion	0.239	0.224
rate_multiple_or_days	0.225	0.301
rate_dialysis	0.139	0.060
rate_or	0.083	0.277
avg_n_distinct_hcps	-0.056	0.146

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=8 codes)

code	Description	Score	N claims	Key drivers
8E0ZXY6	ISOLATION	-2.599	3134	n distinct rev codes (-0.50), work rvu (-0.33), relative claim charge (-0.32)
0DH64UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS ENDOSCOPIC APPROACH	-2.788	1414	organ system count (-0.46), icu (-0.44), n distinct rev codes (-0.44)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.327	1509	n distinct rev codes (-0.59), work rvu (-0.44), relative claim charge (-0.43)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.769	1586	n distinct rev codes (-0.63), length of stay (-0.46), relative claim charge (-0.44)
8E0W4CZ	ROBOTIC ASSISTED PROCEDURE OF TRUNK REGION, PERCUTANEOUS ENDOSCOPIC APPROACH	-4.546	2362	n distinct rev codes (-0.70), length of stay (-0.64), icu (-0.59)
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-4.725	2231	organ system count (-0.86), length of stay (-0.66), n distinct rev codes (-0.64)
10907ZC	DRAINAGE OF AMNIOTIC FLUID, THERAPEUTIC FROM PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-5.077	1114	organ system count (-0.93), n distinct rev codes (-0.86), icu (-0.61)
0VTTXZZ	RESECTION OF PREPUCE, EXTERNAL APPROACH	-5.406	1243	organ system count (-1.13), length of stay (-0.81), n distinct rev codes (-0.70)

Tier 2 (n=27 codes)

code	Description	Score	N claims	Key drivers
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	0.407	5006	multiple or days (+0.45), relative claim charge (-0.15), organ system count (+0.14)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	0.218	1769	n j code lines (+0.53), length of stay (+0.28), work rvu (+0.24)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	0.107	982	work rvu (-0.23), n j code lines (-0.19), icu (+0.19)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.012	2429	n distinct rev codes (+0.26), multiple or days (+0.22), work rvu (-0.18)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	-0.043	1939	length of stay (+0.43), icu (-0.33), relative claim charge (+0.31)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-0.054	4199	multiple or days (+0.46), icu (-0.22), n j code lines (-0.12)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.129	5106	n distinct rev codes (+0.24), multiple or days (+0.24), n j code lines (-0.20)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.235	1534	n distinct rev codes (+0.24), length of stay (-0.19), transfusion (-0.16)
4A03X5D	MEASUREMENT OF ARTERIAL FLOW, INTRACRANIAL, EXTERNAL APPROACH	-0.320	1152	n imaging lines (+0.77), length of stay (-0.24), n j code lines (-0.21)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.379	8704	icu (+0.22), length of stay (-0.22), dialysis (+0.16)

Tier 3 (n=16 codes)

code	Description	Score	N claims	Key drivers
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.476	1471	icu (+0.73), n j code lines (+0.66), work rvu (+0.54)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	2.800	2094	multiple or days (+0.49), n distinct rev codes (+0.41), work rvu (+0.37)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	2.675	3080	multiple or days (+0.61), dialysis (+0.42), n distinct rev codes (+0.41)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	2.554	1501	mechanical ventilation (+0.94), icu (+0.48), work rvu (+0.40)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	2.159	10481	multiple or days (+0.35), icu (+0.31), n distinct rev codes (+0.28)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.934	2245	n imaging lines (+0.62), n distinct rev codes (+0.33), work rvu (+0.32)
4A00X4Z	MEASUREMENT OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	1.796	952	work rvu (+0.92), n j code lines (+0.76), n imaging lines (+0.52)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	1.720	1336	icu (+0.47), work rvu (+0.34), n j code lines (+0.24)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.717	10906	transfusion (+1.31), organ system count (+0.19), n distinct rev codes (+0.16)
B548ZZA	ULTRASONOGRAPHY OF SUPERIOR VENA CAVA, GUIDANCE	1.420	1269	icu (+0.33), n distinct rev codes (+0.28), length of stay (+0.25)

Tier 4 (n=4 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	8.026	1105	relative claim charge (+1.57), length of stay (+1.09), n j code lines (+1.01)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	5.358	2006	mechanical ventilation (+0.94), icu (+0.79), work rvu (+0.73)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	5.156	3570	mechanical ventilation (+0.80), relative claim charge (+0.71), work rvu (+0.68)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	4.504	1161	icu (+0.80), relative claim charge (+0.64), work rvu (+0.60)

Key Driver Frequency

feature	count	pct
n distinct rev codes	28	50.900
work rvu	22	40.000
icu	22	40.000
length of stay	19	34.500
n j code lines	17	30.900
relative claim charge	16	29.100
multiple or days	14	25.500
organ system count	9	16.400
n imaging lines	5	9.100
dialysis	5	9.100
transfusion	4	7.300
mechanical ventilation	3	5.500
n distinct hcps	1	1.800