IP - MS.1.lower_joint_replacement

CM Codes

Data Overview

16174 total codes in komodo_rii; 417 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	268
CC	101
MCC	48

PCA Analysis

PC1 explains 39.9% of variance; PC1+PC2 together explain 53.6%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	n imaging lines	organ system count	relative claim charge	icu	transfusion	work rvu
1	162.000	1304727.000	18.146	5.049	0.574	5.667	0.995	0.093	0.184	0.549
2	212.000	1046373.000	21.030	6.907	1.033	5.996	1.116	0.176	0.331	0.605
3	43.000	106274.000	23.849	10.041	1.309	6.287	1.410	0.340	0.423	0.777

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	13	73	15	101
MCC	8	23	17	48
No CC/MCC	141	116	11	268
All	162	212	43	417

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.396	-0.066	0.456
rate_icu	0.377	-0.043	0.463
rate_transfusion	0.359	-0.031	0.447
avg_length_of_stay	0.347	-0.107	0.406
avg_n_imaging_lines	0.342	-0.098	0.447
avg_relative_claim_charge	0.333	-0.180	0.471
rate_mechanical_ventilation	0.288	-0.052	0.507
rate_multiple_or_days	0.230	0.018	0.314
avg_organ_system_count	0.188	-0.023	-0.200
avg_work_rvu	0.144	-0.157	0.128
rate_dialysis	0.121	0.015	0.501
avg_n_distinct_hcps	0.111	-0.227	-0.147
avg_n_j_code_lines	0.064	-0.123	0.178
rate_or	0.028	-0.089	-0.016

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
E8729	Other acidosis	No CC/MCC	5.583	3	1040	icu (+1.36), mechanical ventilation (+1.05), relative claim charge (+0.90)
E8770	Fluid overload, unspecified	No CC/MCC	5.362	3	857	multiple or days (+0.90), relative claim charge (+0.87), icu (+0.57)
G928	Other toxic encephalopathy	No CC/MCC	4.544	3	4145	relative claim charge (+0.70), icu (+0.60), n distinct rev codes (+0.57)
S72141D	Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing	No CC/MCC	3.857	3	1475	length of stay (+2.15), n distinct rev codes (+0.97), relative claim charge (-0.64)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	3.783	3	809	icu (+0.74), n distinct rev codes (+0.61), n imaging lines (+0.49)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
S72011A	Unspecified intracapsular fracture of right femur, initial encounter for closed fracture	MCC	-1.995	1	6255	transfusion (-0.73), relative claim charge (-0.61), n imaging lines (+0.23)
S72012A	Unspecified intracapsular fracture of left femur, initial encounter for closed fracture	MCC	-1.986	1	6360	transfusion (-0.75), relative claim charge (-0.59), n imaging lines (+0.30)
G800	Spastic quadriplegic cerebral palsy	MCC	-1.639	1	1151	n distinct rev codes (-0.85), n imaging lines (-0.76), icu (+0.70)
S72092A	Other fracture of head and neck of left femur, initial encounter for closed fracture	MCC	-1.202	1	1112	transfusion (-0.44), relative claim charge (-0.32), organ system count (-0.21)
S72321A	Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture	MCC	-1.048	1	980	organ system count (-0.69), length of stay (-0.35), n imaging lines (+0.28)

Top Codes by Tier

Tier 1 (n=162 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I4510	Unspecified right bundle-branch block	No CC/MCC	-0.746	2837	transfusion (-0.18), work rvu (-0.13), length of stay (-0.13)
N319	Neuromuscular dysfunction of bladder, unspecified	No CC/MCC	-0.746	980	organ system count (+0.24), n imaging lines (-0.20), work rvu (-0.19)
S72322A	Displaced transverse fracture of shaft of left femur, initial encounter for closed fracture	MCC	-0.766	833	organ system count (-0.69), multiple or days (+0.45), length of stay (-0.37)
S72145A	Nondisplaced intertrochanteric fracture of left femur, initial encounter for closed fracture	MCC	-0.767	5578	relative claim charge (-0.36), transfusion (-0.27), n imaging lines (+0.27)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	-0.774	9831	relative claim charge (-0.21), icu (-0.20), organ system count (+0.14)
D649	Anemia, unspecified	No CC/MCC	-0.786	24431	relative claim charge (-0.21), icu (-0.14), transfusion (-0.10)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	-0.789	19760	relative claim charge (-0.19), transfusion (-0.17), length of stay (-0.13)
M25559	Pain in unspecified hip	No CC/MCC	-0.799	897	relative claim charge (-0.34), multiple or days (-0.30), icu (-0.20)
M62838	Other muscle spasm	No CC/MCC	-0.803	1294	transfusion (-0.28), icu (-0.23), n imaging lines (-0.19)
S50311A	Abrasion of right elbow, initial encounter	No CC/MCC	-0.805	859	relative claim charge (-0.36), transfusion (-0.27), icu (-0.21)

Tier 2 (n=212 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M4854XA	Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture	CC	2.678	1134	n imaging lines (+0.93), n distinct rev codes (+0.54), transfusion (+0.42)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	2.643	2081	icu (+0.67), relative claim charge (+0.41), n distinct rev codes (+0.39)
S72461A	Displaced supracondylar fracture with intracondylar extension of lower end of right femur, initial encounter for closed fracture	CC	2.635	772	transfusion (+0.71), relative claim charge (+0.54), n distinct rev codes (+0.42)
D6959	Other secondary thrombocytopenia	No CC/MCC	2.611	1398	transfusion (+0.78), multiple or days (+0.52), n distinct rev codes (+0.26)
E43	Unspecified severe protein-calorie malnutrition	MCC	2.523	9224	transfusion (+0.47), n distinct rev codes (+0.43), multiple or days (+0.40)
M6282	Rhabdomyolysis	CC	2.493	1915	n imaging lines (+0.54), n distinct rev codes (+0.49), icu (+0.40)
M84551A	Pathological fracture in neoplastic disease, right femur, initial encounter for fracture	CC	2.480	880	multiple or days (+0.64), work rvu (+0.58), n j code lines (+0.43)
M6281	Muscle weakness (generalized)	No CC/MCC	2.471	3286	length of stay (+1.88), relative claim charge (-0.69), n distinct rev codes (+0.69)
E46	Unspecified protein-calorie malnutrition	CC	2.458	2708	length of stay (+0.51), n distinct rev codes (+0.43), transfusion (+0.40)
E8809	Other disorders of plasma-protein metabolism, not elsewhere classified	No CC/MCC	2.387	1862	transfusion (+0.55), n distinct rev codes (+0.44), relative claim charge (+0.42)

Tier 3 (n=43 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	8.996	1128	mechanical ventilation (+2.23), icu (+2.12), relative claim charge (+1.61)
J9602	Acute respiratory failure with hypercapnia	MCC	8.986	1068	mechanical ventilation (+2.72), icu (+2.02), relative claim charge (+1.38)
A419	Sepsis, unspecified organism	MCC	8.916	2857	mechanical ventilation (+1.58), icu (+1.50), relative claim charge (+1.47)
J690	Pneumonitis due to inhalation of food and vomit	MCC	8.226	3333	mechanical ventilation (+1.63), relative claim charge (+1.34), icu (+1.33)
N170	Acute kidney failure with tubular necrosis	MCC	6.517	2863	transfusion (+1.13), relative claim charge (+1.09), icu (+1.00)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	6.460	1118	icu (+1.34), relative claim charge (+1.11), n distinct rev codes (+0.91)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	6.161	3144	icu (+1.44), mechanical ventilation (+1.13), relative claim charge (+1.07)
E8729	Other acidosis	No CC/MCC	5.583	1040	icu (+1.36), mechanical ventilation (+1.05), relative claim charge (+0.90)
J95821	Acute postprocedural respiratory failure	MCC	5.487	811	mechanical ventilation (+2.15), icu (+1.37), relative claim charge (+0.80)
E873	Alkalosis	CC	5.372	783	mechanical ventilation (+0.81), icu (+0.75), relative claim charge (+0.72)

Key Driver Frequency

feature	count	pct
n distinct rev codes	233	55.900
transfusion	223	53.500
relative claim charge	169	40.500
icu	160	38.400
n imaging lines	155	37.200
multiple or days	94	22.500
organ system count	61	14.600
length of stay	55	13.200
work rvu	43	10.300
n distinct hcps	27	6.500
mechanical ventilation	22	5.300
dialysis	7	1.700
n j code lines	2	0.500

PCS Codes

Data Overview

6602 total codes in komodo_rii; 98 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 49.1% of variance; PC1+PC2 together explain 63.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	n imaging lines	relative claim charge	transfusion	icu	mechanical ventilation
1	42.000	180732.000	16.123	3.616	4.544	0.226	0.983	0.120	0.059	0.002
2	47.000	273067.000	20.821	6.446	5.247	1.031	1.181	0.343	0.186	0.011
3	9.000	14293.000	25.528	10.527	6.137	1.400	1.887	0.650	0.552	0.365

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.366	-0.088
avg_length_of_stay	0.363	-0.141
rate_icu	0.350	-0.175
rate_transfusion	0.330	-0.177
avg_n_imaging_lines	0.327	-0.123
avg_relative_claim_charge	0.323	-0.332
avg_organ_system_count	0.281	0.043
rate_mechanical_ventilation	0.223	-0.104
rate_multiple_or_days	0.221	-0.132
avg_n_distinct_hcps	0.220	-0.049
avg_work_rvu	0.155	-0.279
rate_or	0.129	-0.090
rate_dialysis	0.126	-0.010
avg_n_j_code_lines	0.097	-0.259

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=42 codes)

code	Description	Score	N claims	Key drivers
0QP904Z	REMOVAL OF INTERNAL FIXATION DEVICE FROM LEFT FEMORAL SHAFT, OPEN APPROACH	-0.806	781	multiple or days (-0.22), n imaging lines (-0.18), organ system count (-0.16)
3E0T3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	-0.884	22802	transfusion (-0.18), relative claim charge (-0.17), icu (-0.17)
0QH734Z	INSERTION OF INTERNAL FIXATION DEVICE INTO LEFT UPPER FEMUR, PERCUTANEOUS APPROACH	-0.985	3280	relative claim charge (-0.40), transfusion (-0.32), n imaging lines (+0.19)
0QS504Z	REPOSITION LEFT ACETABULUM WITH INTERNAL FIXATION DEVICE, OPEN APPROACH	-0.990	737	organ system count (-0.87), n distinct rev codes (-0.29), or (+0.26)
0QH634Z	INSERTION OF INTERNAL FIXATION DEVICE INTO RIGHT UPPER FEMUR, PERCUTANEOUS APPROACH	-1.043	3122	relative claim charge (-0.41), transfusion (-0.33), n imaging lines (+0.16)
3E0T33Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	-1.253	1417	length of stay (-0.23), transfusion (-0.20), icu (-0.20)
0SRB0J9	REPLACEMENT OF LEFT HIP JOINT WITH SYNTHETIC SUBSTITUTE, CEMENTED, OPEN APPROACH	-1.356	731	n distinct hcps (-0.32), n imaging lines (-0.30), n distinct rev codes (-0.22)
8E0YXBF	COMPUTER ASSISTED PROCEDURE OF LOWER EXTREMITY, WITH FLUOROSCOPY	-1.409	1697	length of stay (-0.28), transfusion (-0.23), icu (-0.20)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.519	1345	work rvu (-0.24), icu (-0.20), transfusion (-0.20)
F07Z9ZZ	GAIT TRAINING/FUNCTIONAL AMBULATION TREATMENT	-1.745	832	or (-0.30), work rvu (-0.23), multiple or days (-0.22)

Tier 2 (n=47 codes)

code	Description	Score	N claims	Key drivers
BQ14ZZZ	FLUOROSCOPY OF LEFT FEMUR	3.006	1140	multiple or days (+1.23), work rvu (+0.67), n distinct rev codes (+0.31)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.823	36275	transfusion (+1.11), n distinct rev codes (+0.39), organ system count (+0.38)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	2.811	1300	n distinct rev codes (+0.54), icu (+0.46), organ system count (+0.42)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	2.762	905	length of stay (+0.65), n distinct rev codes (+0.47), relative claim charge (+0.47)
0QSG04Z	REPOSITION RIGHT TIBIA WITH INTERNAL FIXATION DEVICE, OPEN APPROACH	2.696	1128	relative claim charge (+0.67), organ system count (-0.41), length of stay (+0.41)
BQ13ZZZ	FLUOROSCOPY OF RIGHT FEMUR	2.563	1096	multiple or days (+1.19), work rvu (+0.42), n imaging lines (+0.33)
0QSH04Z	REPOSITION LEFT TIBIA WITH INTERNAL FIXATION DEVICE, OPEN APPROACH	2.497	926	relative claim charge (+0.74), length of stay (+0.41), organ system count (-0.33)
0HQ0XZZ	REPAIR SCALP SKIN, EXTERNAL APPROACH	2.169	953	n imaging lines (+0.80), n distinct rev codes (+0.48), transfusion (+0.24)
0HQ1XZZ	REPAIR FACE SKIN, EXTERNAL APPROACH	2.164	778	n imaging lines (+0.83), n distinct rev codes (+0.51), n distinct hcps (+0.39)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.017	2306	icu (+0.47), length of stay (+0.38), n distinct hcps (-0.28)

Tier 3 (n=9 codes)

code	Description	Score	N claims	Key drivers
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	8.756	746	icu (+1.59), mechanical ventilation (+1.30), relative claim charge (+1.28)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	8.070	1422	icu (+1.44), relative claim charge (+1.24), mechanical ventilation (+1.11)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	6.335	1415	icu (+1.01), relative claim charge (+0.84), length of stay (+0.76)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	6.109	742	icu (+1.32), mechanical ventilation (+1.30), n distinct rev codes (+0.68)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	5.318	3916	length of stay (+0.99), relative claim charge (+0.80), n distinct rev codes (+0.66)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	4.557	807	length of stay (+0.94), transfusion (+0.74), n distinct rev codes (+0.73)
30233R1	TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	4.471	734	transfusion (+1.10), length of stay (+0.53), n distinct rev codes (+0.50)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	4.402	3538	dialysis (+1.22), length of stay (+0.64), organ system count (+0.50)
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	4.276	973	transfusion (+1.10), relative claim charge (+0.66), icu (+0.59)

Key Driver Frequency

feature	count	pct
n imaging lines	59	60.200
n distinct rev codes	59	60.200
length of stay	36	36.700
transfusion	31	31.600
organ system count	26	26.500
relative claim charge	23	23.500
n distinct hcps	15	15.300
icu	14	14.300
work rvu	10	10.200
or	9	9.200
multiple or days	6	6.100
mechanical ventilation	3	3.100
n j code lines	2	2.000
dialysis	1	1.000