IP - OB.1.vaginal

CM Codes

Data Overview

8438 total codes in komodo_rii; 188 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	142
CC	35
MCC	11

PCA Analysis

PC1 explains 39.6% of variance; PC1+PC2 together explain 52.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	transfusion	n j code lines	or	n imaging lines
1	120.000	3429643.000	10.153	1.990	1.040	1.211	0.033	0.458	0.142	0.009
2	51.000	555155.000	10.697	2.283	1.182	1.300	0.051	0.513	0.164	0.018
3	17.000	90322.000	11.597	2.809	1.450	1.451	0.109	0.533	0.196	0.051

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	13	17	5	35
MCC	0	8	3	11
No CC/MCC	107	26	9	142
All	120	51	17	188

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.386	-0.278	0.437
avg_n_distinct_rev_codes	0.378	-0.230	0.431
rate_icu	0.373	-0.187	0.422
rate_mechanical_ventilation	0.337	0.040	0.191
avg_n_imaging_lines	0.316	-0.209	0.290
avg_length_of_stay	0.300	-0.346	0.174
rate_transfusion	0.271	-0.247	0.373
rate_or	0.245	-0.300	0.248
rate_dialysis	0.232	0.173	0.176
rate_multiple_or_days	0.200	-0.079	0.149
avg_n_j_code_lines	0.181	-0.083	0.265
avg_organ_system_count	0.068	-0.136	-0.021
avg_work_rvu	-0.011	-0.174	-0.073
avg_n_distinct_hcps	-0.013	-0.319	-0.169

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
E876	Hypokalemia	No CC/MCC	8.455	3	2670	icu (+1.62), n imaging lines (+1.57), n distinct rev codes (+1.35)
O42113	Preterm premature rupture of membranes, onset of labor more than 24 hours following rupture, third trimester	No CC/MCC	8.183	3	2815	relative claim charge (+2.57), length of stay (+2.57), n distinct rev codes (+1.23)
O114	Pre-existing hypertension with pre-eclampsia, complicating childbirth	No CC/MCC	7.271	3	8413	icu (+1.83), relative claim charge (+1.20), n distinct rev codes (+1.00)
O1415	Severe pre-eclampsia, complicating the puerperium	No CC/MCC	7.051	3	2269	icu (+1.72), n imaging lines (+1.32), mechanical ventilation (+0.92)
O1414	Severe pre-eclampsia complicating childbirth	No CC/MCC	6.533	3	24178	icu (+1.92), relative claim charge (+1.23), n distinct rev codes (+1.10)

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

None.

Top Codes by Tier

Tier 1 (n=120 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-0.195	24025	mechanical ventilation (-0.16), n j code lines (+0.15), transfusion (-0.14)
O4103X0	Oligohydramnios, third trimester, not applicable or unspecified	CC	-0.266	18510	n imaging lines (-0.18), n j code lines (+0.14), n distinct rev codes (+0.13)
O99324	Drug use complicating childbirth	CC	-0.287	23439	n j code lines (-0.35), mechanical ventilation (+0.29), dialysis (-0.14)
O99284	Endocrine, nutritional and metabolic diseases complicating childbirth	No CC/MCC	-0.326	62104	dialysis (+0.23), n distinct rev codes (-0.17), length of stay (-0.13)
F1210	Cannabis abuse, uncomplicated	No CC/MCC	-0.340	2303	n j code lines (-0.43), transfusion (+0.33), or (+0.25)
O731	Retained portions of placenta and membranes, without hemorrhage	No CC/MCC	-0.360	2211	or (+0.40), multiple or days (-0.22), icu (-0.17)
O35BXX0	Maternal care for other (suspected) fetal abnormality and damage, fetal cardiac anomalies, not applicable or unspecified	No CC/MCC	-0.386	4131	or (+0.40), n distinct rev codes (-0.29), mechanical ventilation (-0.21)
F1120	Opioid dependence, uncomplicated	CC	-0.387	2150	n j code lines (-0.39), length of stay (+0.25), mechanical ventilation (-0.21)
O24419	Gestational diabetes mellitus in pregnancy, unspecified control	No CC/MCC	-0.413	2080	length of stay (+0.35), relative claim charge (-0.26), mechanical ventilation (-0.21)
O3413	Maternal care for benign tumor of corpus uteri, third trimester	No CC/MCC	-0.419	9594	n j code lines (+0.23), dialysis (-0.14), n distinct rev codes (-0.13)

Tier 2 (n=51 codes)

code	Description	CMS severity	Score	N claims	Key drivers
O321XX0	Maternal care for breech presentation, not applicable or unspecified	No CC/MCC	3.404	4620	or (+0.66), mechanical ventilation (+0.56), relative claim charge (+0.55)
O864	Pyrexia of unknown origin following delivery	CC	3.208	2101	n imaging lines (+0.68), multiple or days (+0.52), n distinct rev codes (+0.49)
O30043	Twin pregnancy, dichorionic/diamniotic, third trimester	No CC/MCC	3.182	3981	relative claim charge (+0.70), n distinct rev codes (+0.57), or (+0.45)
O364XX0	Maternal care for intrauterine death, not applicable or unspecified	CC	3.169	4116	icu (+0.90), mechanical ventilation (+0.77), relative claim charge (+0.43)
O721	Other immediate postpartum hemorrhage	CC	2.798	39298	transfusion (+1.13), relative claim charge (+0.46), n distinct rev codes (+0.24)
O2412	Pre-existing type 2 diabetes mellitus, in childbirth	MCC	2.551	5953	icu (+0.57), relative claim charge (+0.48), length of stay (+0.39)
O42913	Preterm premature rupture of membranes, unspecified as to length of time between rupture and onset of labor, third trimester	No CC/MCC	2.051	12007	n distinct rev codes (+0.75), length of stay (+0.67), relative claim charge (+0.63)
D62	Acute posthemorrhagic anemia	CC	1.967	55814	transfusion (+0.68), n j code lines (+0.31), n distinct rev codes (+0.25)
O411230	Chorioamnionitis, third trimester, not applicable or unspecified	MCC	1.875	20838	n distinct rev codes (+0.51), relative claim charge (+0.45), n j code lines (+0.40)
O99891	Other specified diseases and conditions complicating pregnancy	No CC/MCC	1.825	2974	n distinct rev codes (+0.49), multiple or days (+0.43), n imaging lines (+0.31)

Tier 3 (n=17 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E876	Hypokalemia	No CC/MCC	8.455	2670	icu (+1.62), n imaging lines (+1.57), n distinct rev codes (+1.35)
O6012X0	Preterm labor second trimester with preterm delivery second trimester, not applicable or unspecified	MCC	8.242	2731	dialysis (+1.77), mechanical ventilation (+1.65), icu (+1.16)
O42113	Preterm premature rupture of membranes, onset of labor more than 24 hours following rupture, third trimester	No CC/MCC	8.183	2815	relative claim charge (+2.57), length of stay (+2.57), n distinct rev codes (+1.23)
O114	Pre-existing hypertension with pre-eclampsia, complicating childbirth	No CC/MCC	7.271	8413	icu (+1.83), relative claim charge (+1.20), n distinct rev codes (+1.00)
O1415	Severe pre-eclampsia, complicating the puerperium	No CC/MCC	7.051	2269	icu (+1.72), n imaging lines (+1.32), mechanical ventilation (+0.92)
O753	Other infection during labor	MCC	6.555	3015	mechanical ventilation (+1.29), n imaging lines (+1.18), icu (+1.06)
O1414	Severe pre-eclampsia complicating childbirth	No CC/MCC	6.533	24178	icu (+1.92), relative claim charge (+1.23), n distinct rev codes (+1.10)
O720	Third-stage hemorrhage	CC	6.498	6664	transfusion (+1.51), or (+1.26), mechanical ventilation (+0.98)
O713	Obstetric laceration of cervix	CC	6.405	3230	or (+1.29), transfusion (+1.08), relative claim charge (+0.86)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	6.332	2547	mechanical ventilation (+1.15), n distinct rev codes (+0.86), icu (+0.76)

Key Driver Frequency

feature	count	pct
n distinct rev codes	109	58.000
relative claim charge	83	44.100
icu	64	34.000
mechanical ventilation	59	31.400
length of stay	52	27.700
multiple or days	40	21.300
n j code lines	36	19.100
n imaging lines	36	19.100
or	33	17.600
dialysis	27	14.400
transfusion	23	12.200
organ system count	2	1.100

PCS Codes

Data Overview

1535 total codes in komodo_rii; 47 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 50.8% of variance; PC1+PC2 together explain 66.5%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	relative claim charge	length of stay	transfusion	organ system count	or	n j code lines	work rvu
1	21.000	2379977.000	10.171	1.054	1.989	0.034	0.766	0.156	0.474	0.125
2	19.000	356986.000	10.795	1.187	2.213	0.046	0.925	0.183	0.524	0.150
3	4.000	22586.000	11.192	1.338	2.289	0.081	1.063	0.435	0.596	0.244
4	3.000	19158.000	12.731	1.775	2.619	0.541	1.272	0.389	0.574	0.188

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
rate_icu	0.349	0.015
avg_n_imaging_lines	0.344	-0.265
rate_mechanical_ventilation	0.344	0.190
avg_relative_claim_charge	0.332	-0.308
rate_transfusion	0.323	-0.242
rate_dialysis	0.317	0.227
avg_organ_system_count	0.284	-0.219
avg_n_distinct_rev_codes	0.265	-0.341
rate_multiple_or_days	0.238	0.062
rate_or	0.221	-0.235
avg_length_of_stay	0.177	-0.143
avg_work_rvu	0.148	-0.015
avg_n_j_code_lines	0.128	-0.156
avg_n_distinct_hcps	0.034	-0.016

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=21 codes)

code	Description	Score	N claims	Key drivers
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-0.930	22444	n imaging lines (-0.29), organ system count (-0.29), n distinct rev codes (+0.25)
10S0XZZ	REPOSITION PRODUCTS OF CONCEPTION, EXTERNAL APPROACH	-1.020	3898	multiple or days (-0.20), dialysis (-0.19), mechanical ventilation (-0.16)
4A0HXCZ	MEASUREMENT OF PRODUCTS OF CONCEPTION, CARDIAC RATE, EXTERNAL APPROACH	-1.031	3586	icu (-0.23), multiple or days (-0.20), mechanical ventilation (-0.16)
0DQR0ZZ	REPAIR ANAL SPHINCTER, OPEN APPROACH	-1.091	16343	organ system count (-0.26), multiple or days (-0.16), mechanical ventilation (-0.16)
3E033VJ	INTRODUCTION OF OTHER HORMONE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.128	249327	relative claim charge (-0.19), n distinct rev codes (-0.16), n imaging lines (-0.13)
10D07Z6	EXTRACTION OF PRODUCTS OF CONCEPTION, VACUUM, VIA NATURAL OR ARTIFICIAL OPENING	-1.387	41084	organ system count (-0.36), length of stay (-0.19), multiple or days (-0.15)
0UQGXZZ	REPAIR VAGINA, EXTERNAL APPROACH	-1.405	18302	organ system count (-0.18), relative claim charge (-0.17), n imaging lines (-0.15)
4A1HXCZ	MONITORING OF PRODUCTS OF CONCEPTION, CARDIAC RATE, EXTERNAL APPROACH	-1.494	129269	relative claim charge (-0.27), n distinct rev codes (-0.26), n imaging lines (-0.16)
10907ZC	DRAINAGE OF AMNIOTIC FLUID, THERAPEUTIC FROM PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-1.522	347672	relative claim charge (-0.26), n distinct rev codes (-0.19), n imaging lines (-0.14)
3E0R3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO SPINAL CANAL, PERCUTANEOUS APPROACH	-1.691	35105	icu (-0.33), n distinct rev codes (-0.23), relative claim charge (-0.21)

Tier 2 (n=19 codes)

code	Description	Score	N claims	Key drivers
10D07Z3	EXTRACTION OF PRODUCTS OF CONCEPTION, LOW FORCEPS, VIA NATURAL OR ARTIFICIAL OPENING	0.836	6086	multiple or days (+0.34), n imaging lines (+0.32), icu (+0.19)
10D17Z9	MANUAL EXTRACTION OF PRODUCTS OF CONCEPTION, RETAINED, VIA NATURAL OR ARTIFICIAL OPENING	0.807	14539	work rvu (+0.14), mechanical ventilation (+0.13), icu (+0.11)
3E0E7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	0.531	3121	work rvu (+0.34), multiple or days (+0.32), organ system count (+0.25)
0U7C7ZZ	DILATION OF CERVIX, VIA NATURAL OR ARTIFICIAL OPENING	0.481	73990	length of stay (+0.26), organ system count (+0.24), icu (+0.15)
0U7C7DJ	None	0.464	2076	relative claim charge (+0.45), n imaging lines (+0.45), length of stay (-0.36)
3E0P7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO FEMALE REPRODUCTIVE, VIA NATURAL OR ARTIFICIAL OPENING	0.330	5019	length of stay (+0.26), dialysis (-0.19), icu (+0.18)
10H07YZ	INSERTION OF OTHER DEVICE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-0.053	48085	organ system count (+0.18), length of stay (+0.13), transfusion (-0.10)
3E0P7VZ	INTRODUCTION OF HORMONE INTO FEMALE REPRODUCTIVE, VIA NATURAL OR ARTIFICIAL OPENING	-0.108	98499	length of stay (+0.17), icu (+0.11), transfusion (-0.09)
3E0E77Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-0.173	3409	dialysis (+0.46), multiple or days (-0.20), icu (-0.18)
4A1H74Z	MONITORING OF PRODUCTS OF CONCEPTION, CARDIAC ELECTRICAL ACTIVITY, VIA NATURAL OR ARTIFICIAL OPENING	-0.264	4119	organ system count (+0.44), dialysis (-0.19), mechanical ventilation (-0.16)

Tier 3 (n=4 codes)

code	Description	Score	N claims	Key drivers
0UB70ZZ	EXCISION OF BILATERAL FALLOPIAN TUBES, OPEN APPROACH	3.290	6233	or (+1.13), relative claim charge (+0.74), n distinct rev codes (+0.65)
0UQC7ZZ	REPAIR CERVIX, VIA NATURAL OR ARTIFICIAL OPENING	3.241	2605	mechanical ventilation (+0.57), icu (+0.55), relative claim charge (+0.47)
0UH97HZ	INSERTION OF CONTRACEPTIVE DEVICE INTO UTERUS, VIA NATURAL OR ARTIFICIAL OPENING	1.682	5818	multiple or days (+0.89), organ system count (+0.43), work rvu (+0.24)
0JHF3HZ	INSERTION OF CONTRACEPTIVE DEVICE INTO LEFT UPPER ARM SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	1.597	7930	work rvu (+0.56), organ system count (+0.37), n j code lines (+0.25)

Tier 4 (n=3 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	11.520	6950	transfusion (+1.92), n imaging lines (+1.73), icu (+1.50)
10D17ZZ	EXTRACTION OF PRODUCTS OF CONCEPTION, RETAINED, VIA NATURAL OR ARTIFICIAL OPENING	8.122	4936	mechanical ventilation (+1.36), dialysis (+1.03), relative claim charge (+0.97)
0W3R7ZZ	CONTROL BLEEDING IN GENITOURINARY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	6.609	7272	icu (+1.00), relative claim charge (+0.99), mechanical ventilation (+0.91)

Key Driver Frequency

feature	count	pct
organ system count	22	46.800
relative claim charge	18	38.300
icu	17	36.200
n distinct rev codes	13	27.700
multiple or days	13	27.700
n imaging lines	12	25.500
mechanical ventilation	12	25.500
dialysis	9	19.100
length of stay	9	19.100
work rvu	7	14.900
n j code lines	5	10.600
transfusion	3	6.400
or	1	2.100