IP - NU.1.craniotomy

CM Codes

Data Overview

10862 total codes in komodo_rii; 291 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	173
CC	85
MCC	33

PCA Analysis

PC1 explains 45.3% of variance; PC1+PC2 together explain 58.5%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	n imaging lines	relative claim charge	n j code lines	work rvu	mechanical ventilation
1	15.000	33811.000	3.542	15.211	3.975	0.885	0.734	0.642	1.122	0.014
2	82.000	300350.000	5.992	19.000	4.986	1.415	0.947	0.766	1.349	0.036
3	110.000	311935.000	8.351	21.924	5.208	1.794	1.077	0.902	1.534	0.069
4	60.000	127147.000	11.935	24.750	5.417	2.084	1.339	1.089	1.457	0.174
5	24.000	33413.000	15.852	26.816	5.712	2.282	1.716	1.363	1.859	0.333

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	3	13	34	27	8	85
MCC	0	2	7	12	12	33
No CC/MCC	12	67	69	21	4	173
All	15	82	110	60	24	291

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.380	-0.060	0.503
avg_length_of_stay	0.366	-0.119	0.492
avg_relative_claim_charge	0.360	-0.120	0.520
rate_transfusion	0.329	-0.054	0.421
avg_n_imaging_lines	0.328	-0.090	0.499
rate_mechanical_ventilation	0.318	-0.022	0.400
rate_icu	0.293	0.051	0.408
avg_n_j_code_lines	0.235	-0.035	0.294
avg_n_distinct_hcps	0.203	-0.232	0.028
rate_multiple_or_days	0.201	-0.114	0.209
avg_organ_system_count	0.193	-0.067	-0.191
rate_dialysis	0.089	0.024	0.345
avg_work_rvu	0.087	-0.047	0.059
rate_or	-0.001	-0.061	0.020

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G40901	Epilepsy, unspecified, not intractable, with status epilepticus	No CC/MCC	5.080	5	623	mechanical ventilation (+1.30), relative claim charge (+0.74), n distinct rev codes (+0.70)
E861	Hypovolemia	No CC/MCC	4.289	5	670	multiple or days (+0.77), n j code lines (+0.51), length of stay (+0.46)
G928	Other toxic encephalopathy	No CC/MCC	4.276	5	1665	length of stay (+0.81), n distinct rev codes (+0.70), relative claim charge (+0.67)
S066XAA	Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, initial encounter	No CC/MCC	4.261	5	1058	mechanical ventilation (+0.90), transfusion (+0.64), n distinct rev codes (+0.45)

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

None.

Top Codes by Tier

Tier 1 (n=15 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I700	Atherosclerosis of aorta	No CC/MCC	-3.635	716	icu (-1.14), n distinct hcps (+0.93), n distinct rev codes (-0.92)
G9612	Meningeal adhesions (cerebral) (spinal)	No CC/MCC	-3.819	515	n imaging lines (-0.70), n distinct rev codes (-0.58), length of stay (-0.48)
I671	Cerebral aneurysm, nonruptured	No CC/MCC	-3.837	14500	n imaging lines (-0.75), n distinct rev codes (-0.72), length of stay (-0.63)
I6523	Occlusion and stenosis of bilateral carotid arteries	No CC/MCC	-4.044	1240	n imaging lines (-0.70), n distinct rev codes (-0.57), length of stay (-0.46)
G9601	Cranial cerebrospinal fluid leak, spontaneous	No CC/MCC	-4.399	1117	n distinct rev codes (-0.78), n imaging lines (-0.77), icu (-0.64)
G950	Syringomyelia and syringobulbia	CC	-4.451	1652	n imaging lines (-0.76), n distinct rev codes (-0.68), organ system count (-0.56)
G500	Trigeminal neuralgia	No CC/MCC	-4.579	3498	n imaging lines (-0.83), n distinct rev codes (-0.71), relative claim charge (-0.68)
I6522	Occlusion and stenosis of left carotid artery	No CC/MCC	-4.745	1246	n imaging lines (-0.87), n distinct rev codes (-0.70), relative claim charge (-0.58)
I6521	Occlusion and stenosis of right carotid artery	No CC/MCC	-5.044	1284	n imaging lines (-0.90), n distinct rev codes (-0.75), relative claim charge (-0.62)
Q018	Encephalocele of other sites	CC	-5.065	1082	n distinct rev codes (-0.77), n imaging lines (-0.73), relative claim charge (-0.59)

Tier 2 (n=82 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I6203	Nontraumatic chronic subdural hemorrhage	MCC	-1.195	2952	relative claim charge (-0.40), n imaging lines (-0.26), n distinct hcps (+0.18)
J439	Emphysema, unspecified	No CC/MCC	-1.266	1524	n j code lines (-0.36), multiple or days (-0.24), relative claim charge (-0.21)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	-1.282	3968	relative claim charge (-0.28), length of stay (-0.24), n distinct rev codes (-0.20)
M5450	Low back pain, unspecified	No CC/MCC	-1.317	653	length of stay (-0.29), n distinct rev codes (-0.29), relative claim charge (-0.27)
H5462	Unqualified visual loss, left eye, normal vision right eye	No CC/MCC	-1.361	522	n distinct hcps (-0.32), n distinct rev codes (-0.24), mechanical ventilation (-0.23)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	-1.361	5745	relative claim charge (-0.22), n j code lines (-0.21), organ system count (+0.20)
M109	Gout, unspecified	No CC/MCC	-1.379	1275	organ system count (+0.28), n j code lines (-0.23), multiple or days (-0.22)
I509	Heart failure, unspecified	No CC/MCC	-1.405	1282	n j code lines (-0.28), relative claim charge (-0.21), n imaging lines (-0.21)
C713	Malignant neoplasm of parietal lobe	CC	-1.407	2020	transfusion (-0.35), n imaging lines (+0.27), relative claim charge (-0.27)
M542	Cervicalgia	No CC/MCC	-1.438	606	relative claim charge (-0.32), length of stay (-0.27), transfusion (-0.26)

Tier 3 (n=110 codes)

code	Description	CMS severity	Score	N claims	Key drivers
H5500	Unspecified nystagmus	No CC/MCC	1.014	566	n j code lines (+0.31), work rvu (+0.27), icu (+0.19)
S06A0XA	Traumatic brain compression without herniation, initial encounter	No CC/MCC	0.960	6485	transfusion (+0.28), icu (+0.23), multiple or days (+0.22)
E8342	Hypomagnesemia	No CC/MCC	0.953	2596	icu (+0.28), n distinct rev codes (+0.18), organ system count (+0.16)
E878	Other disorders of electrolyte and fluid balance, not elsewhere classified	No CC/MCC	0.925	1151	n distinct hcps (+0.55), icu (+0.38), multiple or days (-0.27)
K5900	Constipation, unspecified	No CC/MCC	0.917	4633	organ system count (+0.20), length of stay (+0.20), n distinct hcps (+0.16)
I6200	Nontraumatic subdural hemorrhage, unspecified	MCC	0.916	2790	icu (+0.23), transfusion (+0.21), n distinct rev codes (+0.13)
I6201	Nontraumatic acute subdural hemorrhage	MCC	0.862	3281	transfusion (+0.38), icu (+0.30), mechanical ventilation (+0.22)
G4089	Other seizures	CC	0.824	740	n imaging lines (+0.31), n distinct rev codes (+0.18), multiple or days (+0.13)
S065XAA	Traumatic subdural hemorrhage with loss of consciousness status unknown, initial encounter	No CC/MCC	0.728	14006	transfusion (+0.27), icu (+0.19), mechanical ventilation (+0.19)
I4819	Other persistent atrial fibrillation	CC	0.728	568	n distinct hcps (+0.28), n j code lines (+0.19), n distinct rev codes (+0.13)

Tier 4 (n=60 codes)

code	Description	CMS severity	Score	N claims	Key drivers
B9620	Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere	No CC/MCC	3.569	626	length of stay (+0.82), organ system count (+0.54), n distinct rev codes (+0.45)
G9340	Encephalopathy, unspecified	CC	3.367	5420	n distinct rev codes (+0.58), length of stay (+0.51), n imaging lines (+0.41)
J9811	Atelectasis	CC	3.347	1927	relative claim charge (+0.53), length of stay (+0.47), n distinct rev codes (+0.38)
U071	COVID-19	MCC	3.345	938	multiple or days (+1.06), length of stay (+0.63), relative claim charge (+0.44)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	3.316	550	dialysis (+0.97), transfusion (+0.89), n distinct rev codes (+0.36)
I619	Nontraumatic intracerebral hemorrhage, unspecified	MCC	3.266	1186	n j code lines (+0.93), n imaging lines (+0.60), n distinct rev codes (+0.48)
S06A1XA	Traumatic brain compression with herniation, initial encounter	No CC/MCC	3.229	3478	transfusion (+0.77), mechanical ventilation (+0.71), icu (+0.41)
E43	Unspecified severe protein-calorie malnutrition	MCC	3.192	2941	length of stay (+0.68), relative claim charge (+0.59), n distinct rev codes (+0.59)
S061XAA	Traumatic cerebral edema with loss of consciousness status unknown, initial encounter	No CC/MCC	3.181	1242	mechanical ventilation (+0.66), transfusion (+0.54), n distinct rev codes (+0.46)
S066X0A	Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter	MCC	3.174	506	transfusion (+0.69), mechanical ventilation (+0.59), n distinct hcps (+0.49)

Tier 5 (n=24 codes)

code	Description	CMS severity	Score	N claims	Key drivers
A419	Sepsis, unspecified organism	MCC	7.596	1322	relative claim charge (+1.41), length of stay (+1.24), n distinct rev codes (+0.88)
J690	Pneumonitis due to inhalation of food and vomit	MCC	7.191	2490	relative claim charge (+1.30), length of stay (+1.16), mechanical ventilation (+1.08)
J189	Pneumonia, unspecified organism	MCC	6.080	1558	relative claim charge (+0.91), length of stay (+0.86), n distinct rev codes (+0.75)
J9602	Acute respiratory failure with hypercapnia	MCC	6.015	872	mechanical ventilation (+1.61), relative claim charge (+0.92), transfusion (+0.79)
J9690	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	MCC	5.998	641	mechanical ventilation (+1.57), transfusion (+0.90), n j code lines (+0.77)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	5.938	2194	mechanical ventilation (+1.62), transfusion (+0.85), relative claim charge (+0.72)
J9601	Acute respiratory failure with hypoxia	MCC	5.771	6762	mechanical ventilation (+1.26), relative claim charge (+0.92), n distinct rev codes (+0.73)
E870	Hyperosmolality and hypernatremia	CC	5.712	2928	relative claim charge (+0.97), length of stay (+0.91), mechanical ventilation (+0.77)
J90	Pleural effusion, not elsewhere classified	CC	5.693	734	relative claim charge (+0.84), length of stay (+0.74), n distinct rev codes (+0.67)
B370	Candidal stomatitis	CC	5.163	533	length of stay (+1.43), relative claim charge (+1.22), n distinct rev codes (+0.75)

Key Driver Frequency

feature	count	pct
n distinct rev codes	156	53.600
length of stay	121	41.600
relative claim charge	110	37.800
n imaging lines	90	30.900
transfusion	85	29.200
n j code lines	72	24.700
icu	52	17.900
organ system count	51	17.500
n distinct hcps	48	16.500
mechanical ventilation	43	14.800
multiple or days	36	12.400
work rvu	6	2.100
dialysis	3	1.000

PCS Codes

Data Overview

6097 total codes in komodo_rii; 125 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 47.0% of variance; PC1+PC2 together explain 60.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	n imaging lines	work rvu	relative claim charge	n j code lines	mechanical ventilation
1	13.000	22966.000	14.936	3.507	3.521	0.943	0.858	0.792	0.621	0.011
2	77.000	213740.000	21.223	7.392	4.432	1.652	1.800	1.142	1.028	0.058
3	35.000	65202.000	26.315	14.715	5.225	2.217	1.672	1.663	1.317	0.329

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.376	-0.098
avg_length_of_stay	0.353	-0.133
avg_relative_claim_charge	0.342	-0.153
avg_organ_system_count	0.327	0.023
avg_n_imaging_lines	0.314	-0.066
rate_transfusion	0.292	-0.057
rate_mechanical_ventilation	0.275	-0.036
avg_n_distinct_hcps	0.260	-0.128
rate_icu	0.250	-0.016
avg_n_j_code_lines	0.240	-0.002
rate_multiple_or_days	0.203	0.029
avg_work_rvu	0.107	0.037
rate_dialysis	0.083	0.086
rate_or	0.051	-0.223

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=13 codes)

code	Description	Score	N claims	Key drivers
8E093CZ	ROBOTIC ASSISTED PROCEDURE OF HEAD AND NECK REGION, PERCUTANEOUS APPROACH	-2.870	1269	organ system count (-0.65), n distinct rev codes (-0.61), icu (-0.46)
00164ZB	BYPASS CEREBRAL VENTRICLE TO CEREBRAL CISTERNS, PERCUTANEOUS ENDOSCOPIC APPROACH	-3.101	1023	organ system count (-0.64), relative claim charge (-0.44), n distinct rev codes (-0.40)
00503Z3	DESTRUCTION OF BRAIN USING LASER INTERSTITIAL THERMAL THERAPY, PERCUTANEOUS APPROACH	-3.710	1042	n distinct rev codes (-0.65), organ system count (-0.55), icu (-0.48)
00NK0ZZ	RELEASE TRIGEMINAL NERVE, OPEN APPROACH	-4.187	2895	n imaging lines (-0.68), n distinct rev codes (-0.63), relative claim charge (-0.61)
03VG3HZ	RESTRICTION OF INTRACRANIAL ARTERY WITH INTRALUMINAL DEVICE, FLOW DIVERTER, PERCUTANEOUS APPROACH	-4.420	4556	n distinct rev codes (-0.76), n imaging lines (-0.66), length of stay (-0.55)
005C0ZZ	DESTRUCTION OF CEREBELLUM, OPEN APPROACH	-4.706	1065	n imaging lines (-0.80), organ system count (-0.79), n distinct rev codes (-0.66)
00NC0ZZ	RELEASE CEREBELLUM, OPEN APPROACH	-4.863	2747	organ system count (-0.75), n imaging lines (-0.73), n distinct rev codes (-0.70)
00H00MZ	INSERTION OF NEUROSTIMULATOR LEAD INTO BRAIN, OPEN APPROACH	-4.894	679	n distinct rev codes (-0.85), icu (-0.80), n distinct hcps (-0.59)
057L3DZ	DILATION OF INTRACRANIAL VEIN WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-4.977	637	n distinct rev codes (-0.87), n imaging lines (-0.74), relative claim charge (-0.62)
03CL3ZZ	EXTIRPATION OF MATTER FROM LEFT INTERNAL CAROTID ARTERY, PERCUTANEOUS APPROACH	-5.138	541	n imaging lines (-0.78), n distinct rev codes (-0.67), n distinct hcps (-0.64)

Tier 2 (n=77 codes)

code	Description	Score	N claims	Key drivers
B030YZZ	MAGNETIC RESONANCE IMAGING (MRI) OF BRAIN USING OTHER CONTRAST	1.215	523	n j code lines (+0.45), n imaging lines (+0.39), organ system count (-0.31)
00C40ZZ	EXTIRPATION OF MATTER FROM INTRACRANIAL SUBDURAL SPACE, OPEN APPROACH	1.107	12044	organ system count (+0.33), transfusion (+0.28), n distinct rev codes (+0.27)
B030ZZZ	MAGNETIC RESONANCE IMAGING (MRI) OF BRAIN	0.978	775	n j code lines (+0.41), organ system count (-0.34), work rvu (+0.32)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.892	1613	n distinct hcps (-0.37), organ system count (+0.25), n distinct rev codes (+0.17)
B030Y0Z	MAGNETIC RESONANCE IMAGING (MRI) OF BRAIN USING OTHER CONTRAST, UNENHANCED AND ENHANCED	0.856	505	n imaging lines (+0.50), work rvu (+0.41), multiple or days (-0.28)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	0.757	1289	organ system count (+0.43), n j code lines (-0.19), n distinct rev codes (+0.18)
B31G1ZZ	FLUOROSCOPY OF BILATERAL VERTEBRAL ARTERIES USING LOW OSMOLAR CONTRAST	0.692	1104	multiple or days (+0.52), relative claim charge (+0.22), work rvu (+0.21)
B31C1ZZ	FLUOROSCOPY OF BILATERAL EXTERNAL CAROTID ARTERIES USING LOW OSMOLAR CONTRAST	0.566	2046	multiple or days (+0.27), n distinct hcps (+0.15), relative claim charge (+0.14)
0NR00JZ	REPLACEMENT OF SKULL WITH SYNTHETIC SUBSTITUTE, OPEN APPROACH	0.562	1258	n j code lines (+0.41), work rvu (+0.24), relative claim charge (-0.09)
05BL0ZZ	EXCISION OF INTRACRANIAL VEIN, OPEN APPROACH	0.506	859	n j code lines (+0.59), organ system count (-0.50), multiple or days (+0.44)

Tier 3 (n=35 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	7.234	2998	mechanical ventilation (+1.28), relative claim charge (+1.17), length of stay (+0.89)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	6.574	648	n j code lines (+1.31), length of stay (+0.80), n distinct rev codes (+0.72)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	6.495	1357	length of stay (+1.44), relative claim charge (+1.04), n distinct rev codes (+0.92)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	5.104	1739	length of stay (+0.84), n distinct rev codes (+0.68), relative claim charge (+0.65)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.719	5487	mechanical ventilation (+1.15), n distinct rev codes (+0.63), relative claim charge (+0.56)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	4.705	4234	relative claim charge (+0.65), length of stay (+0.63), n distinct rev codes (+0.60)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	4.508	3569	mechanical ventilation (+1.28), n distinct rev codes (+0.61), organ system count (+0.56)
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	4.206	594	transfusion (+1.38), organ system count (+0.57), n distinct rev codes (+0.52)
06H03DZ	INSERTION OF INTRALUMINAL DEVICE INTO INFERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.902	892	n distinct rev codes (+0.70), length of stay (+0.55), multiple or days (+0.52)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.879	2562	transfusion (+1.31), n distinct rev codes (+0.49), organ system count (+0.44)

Key Driver Frequency

feature	count	pct
n distinct rev codes	57	45.600
length of stay	52	41.600
relative claim charge	49	39.200
n imaging lines	47	37.600
organ system count	42	33.600
n distinct hcps	33	26.400
n j code lines	26	20.800
transfusion	20	16.000
multiple or days	17	13.600
icu	14	11.200
mechanical ventilation	10	8.000
work rvu	7	5.600
dialysis	1	0.800