IP - PU.1.edema

CM Codes

Data Overview

14488 total codes in komodo_rii; 454 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	286
CC	122
MCC	46

PCA Analysis

PC1 explains 38.7% of variance; PC1+PC2 together explain 53.2%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	n imaging lines	work rvu	n j code lines	or
1	57.000	622853.000	12.192	4.082	3.882	0.862	0.282	0.435	0.439	0.035
2	320.000	2441862.000	16.220	6.604	5.784	1.127	0.720	0.578	0.461	0.093
3	77.000	230731.000	17.882	9.279	6.033	1.509	0.872	0.859	0.633	0.183

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	17	78	27	122
MCC	8	25	13	46
No CC/MCC	32	217	37	286
All	57	320	77	454

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.368	-0.075	0.050
rate_or	0.363	-0.146	0.243
avg_relative_claim_charge	0.346	-0.149	0.273
avg_length_of_stay	0.342	-0.087	0.217
rate_transfusion	0.320	-0.024	0.269
avg_n_imaging_lines	0.309	-0.159	-0.017
rate_multiple_or_days	0.284	-0.039	0.180
avg_organ_system_count	0.253	-0.137	-0.388
avg_work_rvu	0.238	-0.138	0.154
avg_n_distinct_hcps	0.155	-0.146	-0.189
avg_n_j_code_lines	0.149	-0.055	0.092
rate_mechanical_ventilation	0.148	0.223	0.127
rate_icu	0.123	0.012	0.302
rate_dialysis	0.117	0.108	0.184

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
K7682	Hepatic encephalopathy	No CC/MCC	5.437	3	775	or (+1.03), transfusion (+0.80), n distinct rev codes (+0.71)
D500	Iron deficiency anemia secondary to blood loss (chronic)	No CC/MCC	4.759	3	1068	transfusion (+1.90), work rvu (+0.67), multiple or days (+0.64)
D6959	Other secondary thrombocytopenia	No CC/MCC	4.627	3	1342	transfusion (+0.95), or (+0.58), relative claim charge (+0.56)
I517	Cardiomegaly	No CC/MCC	4.261	3	976	work rvu (+2.37), n j code lines (+1.60), multiple or days (+0.49)
E11621	Type 2 diabetes mellitus with foot ulcer	No CC/MCC	3.850	3	816	multiple or days (+0.96), n j code lines (+0.40), length of stay (+0.37)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J157	Pneumonia due to Mycoplasma pneumoniae	MCC	-4.643	1	1427	n distinct rev codes (-0.84), organ system count (-0.72), n imaging lines (-0.69)
J129	Viral pneumonia, unspecified	MCC	-3.408	1	2761	n distinct rev codes (-0.61), organ system count (-0.50), n imaging lines (-0.42)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-2.583	1	12854	n distinct rev codes (-0.72), organ system count (-0.55), n imaging lines (-0.54)
J9601	Acute respiratory failure with hypoxia	MCC	-2.358	1	216139	relative claim charge (-0.35), n distinct rev codes (-0.34), organ system count (-0.32)
J121	Respiratory syncytial virus pneumonia	MCC	-2.352	1	2225	organ system count (-0.49), n distinct rev codes (-0.48), n imaging lines (-0.45)

Top Codes by Tier

Tier 1 (n=57 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F339	Major depressive disorder, recurrent, unspecified	CC	-2.090	2249	n distinct rev codes (-0.39), work rvu (-0.29), multiple or days (-0.27)
J9801	Acute bronchospasm	No CC/MCC	-2.118	1421	length of stay (-0.35), or (-0.32), n distinct rev codes (-0.31)
J9691	Respiratory failure, unspecified with hypoxia	MCC	-2.146	3535	n distinct rev codes (-0.43), relative claim charge (-0.39), organ system count (-0.32)
J123	Human metapneumovirus pneumonia	MCC	-2.163	1492	organ system count (-0.48), n imaging lines (-0.45), n distinct rev codes (-0.37)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-2.214	46310	length of stay (-0.35), or (-0.34), relative claim charge (-0.32)
J40	Bronchitis, not specified as acute or chronic	No CC/MCC	-2.221	2106	relative claim charge (-0.41), or (-0.32), multiple or days (-0.27)
J1000	Influenza due to other identified influenza virus with unspecified type of pneumonia	MCC	-2.292	1837	organ system count (-0.31), or (-0.27), multiple or days (-0.27)
J121	Respiratory syncytial virus pneumonia	MCC	-2.352	2225	organ system count (-0.49), n distinct rev codes (-0.48), n imaging lines (-0.45)
J441	Chronic obstructive pulmonary disease with (acute) exacerbation	CC	-2.356	135609	or (-0.38), length of stay (-0.26), n distinct hcps (-0.26)
J9601	Acute respiratory failure with hypoxia	MCC	-2.358	216139	relative claim charge (-0.35), n distinct rev codes (-0.34), organ system count (-0.32)

Tier 2 (n=320 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D849	Immunodeficiency, unspecified	CC	1.686	3351	or (+0.34), transfusion (+0.31), n distinct rev codes (+0.27)
G9341	Metabolic encephalopathy	MCC	1.669	26216	n imaging lines (+0.48), n distinct rev codes (+0.36), icu (+0.27)
M48061	Spinal stenosis, lumbar region without neurogenic claudication	No CC/MCC	1.669	910	n imaging lines (+0.56), work rvu (+0.55), organ system count (+0.42)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	1.615	6995	transfusion (+0.48), length of stay (+0.29), n distinct rev codes (+0.24)
E8352	Hypercalcemia	No CC/MCC	1.614	1793	multiple or days (+0.29), n distinct rev codes (+0.28), n imaging lines (+0.28)
B9689	Other specified bacterial agents as the cause of diseases classified elsewhere	No CC/MCC	1.611	1269	length of stay (+0.50), relative claim charge (+0.30), or (+0.27)
C7802	Secondary malignant neoplasm of left lung	CC	1.584	1626	n imaging lines (+0.50), or (+0.47), work rvu (+0.32)
B370	Candidal stomatitis	CC	1.523	3106	length of stay (+0.83), relative claim charge (+0.50), n distinct rev codes (+0.19)
E11319	Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema	No CC/MCC	1.504	944	mechanical ventilation (+0.46), multiple or days (+0.40), dialysis (+0.27)
I5082	Biventricular heart failure	No CC/MCC	1.503	1255	relative claim charge (+0.39), n distinct rev codes (+0.30), length of stay (+0.25)

Tier 3 (n=77 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I469	Cardiac arrest, cause unspecified	MCC	10.372	834	mechanical ventilation (+1.82), relative claim charge (+1.63), or (+1.06)
D62	Acute posthemorrhagic anemia	CC	9.502	5263	transfusion (+2.83), or (+1.65), relative claim charge (+1.07)
J80	Acute respiratory distress syndrome	MCC	8.377	1424	relative claim charge (+2.30), multiple or days (+1.17), or (+1.02)
K7200	Acute and subacute hepatic failure without coma	MCC	8.183	852	relative claim charge (+1.28), or (+1.13), n distinct rev codes (+0.98)
K567	Ileus, unspecified	CC	7.711	1469	relative claim charge (+1.59), length of stay (+1.22), or (+1.13)
N170	Acute kidney failure with tubular necrosis	MCC	7.052	4289	relative claim charge (+1.07), or (+1.02), length of stay (+0.95)
J939	Pneumothorax, unspecified	CC	6.282	1039	multiple or days (+1.42), or (+1.34), work rvu (+1.20)
K922	Gastrointestinal hemorrhage, unspecified	CC	6.260	1226	transfusion (+2.23), multiple or days (+0.94), length of stay (+0.67)
D689	Coagulation defect, unspecified	CC	6.137	1349	transfusion (+1.20), or (+1.14), relative claim charge (+0.90)
K921	Melena	CC	5.816	1143	transfusion (+1.79), multiple or days (+0.82), or (+0.57)

Key Driver Frequency

feature	count	pct
or	174	38.300
relative claim charge	172	37.900
n distinct rev codes	162	35.700
multiple or days	153	33.700
n imaging lines	128	28.200
organ system count	127	28.000
length of stay	124	27.300
work rvu	98	21.600
transfusion	88	19.400
n distinct hcps	49	10.800
n j code lines	29	6.400
mechanical ventilation	25	5.500
icu	20	4.400
dialysis	13	2.900

PCS Codes

Data Overview

2646 total codes in komodo_rii; 56 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 39.2% of variance; PC1+PC2 together explain 53.8%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	n imaging lines	or	work rvu	n j code lines
1	14.000	139861.000	14.219	6.475	1.097	4.458	0.579	0.071	0.341	0.404
2	14.000	40069.000	17.287	8.237	1.678	4.861	0.693	0.150	0.523	0.538
3	10.000	14232.000	19.307	9.300	1.682	5.080	0.897	0.406	0.624	0.737
4	11.000	15959.000	20.475	10.161	2.174	5.352	1.037	0.409	0.697	0.689
5	7.000	14279.000	21.556	12.429	2.701	5.747	1.045	0.518	0.776	0.719

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.384	-0.399
avg_relative_claim_charge	0.373	-0.324
avg_organ_system_count	0.330	-0.292
rate_or	0.322	-0.396
avg_n_imaging_lines	0.317	-0.471
avg_length_of_stay	0.261	-0.308
rate_multiple_or_days	0.253	-0.244
rate_icu	0.242	-0.044
avg_n_distinct_hcps	0.238	-0.197
avg_work_rvu	0.226	-0.295
rate_transfusion	0.209	-0.176
rate_mechanical_ventilation	0.151	0.033
avg_n_j_code_lines	0.145	-0.210
rate_dialysis	0.120	0.028

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=14 codes)

code	Description	Score	N claims	Key drivers
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-2.243	15712	n imaging lines (-0.34), n distinct rev codes (-0.33), or (-0.29)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-2.260	68463	relative claim charge (-0.38), n distinct rev codes (-0.33), or (-0.30)
4A033R1	MEASUREMENT OF ARTERIAL SATURATION, PERIPHERAL, PERCUTANEOUS APPROACH	-2.459	1593	n distinct hcps (-0.46), relative claim charge (-0.41), work rvu (-0.34)
B32S1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF RIGHT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-2.494	878	n distinct rev codes (-0.64), relative claim charge (-0.48), icu (-0.37)
B32T1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF LEFT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-2.535	852	n distinct rev codes (-0.65), relative claim charge (-0.46), icu (-0.35)
4A12X4Z	MONITORING OF CARDIAC ELECTRICAL ACTIVITY, EXTERNAL APPROACH	-2.702	1899	n imaging lines (-0.85), length of stay (+0.75), n distinct rev codes (-0.68)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.012	1515	relative claim charge (-0.41), icu (-0.37), n distinct rev codes (-0.35)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-3.119	1156	relative claim charge (-0.48), n distinct rev codes (-0.43), organ system count (-0.42)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-3.157	19153	organ system count (-0.66), n distinct rev codes (-0.58), n imaging lines (-0.46)
3E0F7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-3.174	1787	n imaging lines (-0.53), n distinct rev codes (-0.53), relative claim charge (-0.42)

Tier 2 (n=14 codes)

code	Description	Score	N claims	Key drivers
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	-0.215	1310	n distinct hcps (-0.26), length of stay (+0.23), or (+0.19)
5A09557	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.343	4139	relative claim charge (+0.38), length of stay (+0.26), n imaging lines (-0.25)
5A0955A	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-0.394	3335	organ system count (-0.38), relative claim charge (+0.31), n imaging lines (-0.31)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.446	2382	n distinct rev codes (+0.33), or (-0.21), length of stay (-0.17)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.838	13959	dialysis (+0.64), relative claim charge (-0.39), organ system count (+0.38)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	-0.874	1727	n distinct rev codes (+0.27), length of stay (-0.24), or (-0.22)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	-0.878	847	organ system count (-0.67), n distinct hcps (+0.37), n imaging lines (-0.34)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-1.011	2612	relative claim charge (-0.35), n distinct hcps (-0.29), or (-0.25)
B2151ZZ	FLUOROSCOPY OF LEFT HEART USING LOW OSMOLAR CONTRAST	-1.107	856	n distinct rev codes (+0.30), or (-0.25), multiple or days (-0.24)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-1.131	1295	n distinct rev codes (-0.37), n distinct hcps (+0.36), work rvu (-0.30)

Tier 3 (n=10 codes)

code	Description	Score	N claims	Key drivers
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	1.124	949	or (+0.58), organ system count (+0.30), n distinct rev codes (+0.24)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	0.975	829	work rvu (+0.83), n j code lines (+0.80), relative claim charge (-0.35)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	0.909	856	multiple or days (+0.51), length of stay (+0.40), or (+0.23)
0W993ZX	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH, DIAGNOSTIC	0.723	888	or (+0.41), multiple or days (+0.38), n imaging lines (+0.27)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	0.601	2863	or (+0.46), n imaging lines (+0.22), n distinct rev codes (+0.22)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	0.579	4329	or (+0.46), n imaging lines (+0.22), n distinct rev codes (+0.20)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	0.501	1041	mechanical ventilation (+0.26), n distinct rev codes (+0.20), multiple or days (+0.19)
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	0.367	731	length of stay (+0.31), n distinct hcps (-0.28), or (+0.25)
4A023N8	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, BILATERAL, PERCUTANEOUS APPROACH	0.211	721	n distinct rev codes (+0.44), relative claim charge (+0.31), or (-0.20)
0CJS8ZZ	INSPECTION OF LARYNX, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.168	1025	multiple or days (-0.16), work rvu (+0.15), n j code lines (+0.13)

Tier 4 (n=11 codes)

code	Description	Score	N claims	Key drivers
0B9J8ZX	DRAINAGE OF LEFT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.791	784	or (+0.58), n distinct rev codes (+0.40), mechanical ventilation (+0.38)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.666	862	multiple or days (+0.52), or (+0.50), n distinct rev codes (+0.42)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.525	1164	icu (+0.54), organ system count (+0.52), n imaging lines (+0.36)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	2.453	815	n imaging lines (+0.78), relative claim charge (+0.53), work rvu (+0.37)
0W9B30Z	DRAINAGE OF LEFT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	2.295	1001	or (+0.43), multiple or days (+0.38), n imaging lines (+0.27)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.899	1015	transfusion (+0.49), organ system count (+0.49), n distinct rev codes (+0.41)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.758	5953	transfusion (+1.22), organ system count (+0.32), n distinct rev codes (+0.18)
0W9930Z	DRAINAGE OF RIGHT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	1.742	1468	or (+0.41), n imaging lines (+0.28), relative claim charge (+0.27)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.516	1004	n distinct rev codes (+0.47), organ system count (+0.43), transfusion (+0.35)
0BJ08ZZ	INSPECTION OF TRACHEOBRONCHIAL TREE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.488	810	or (+0.53), relative claim charge (+0.38), mechanical ventilation (+0.37)

Tier 5 (n=7 codes)

code	Description	Score	N claims	Key drivers
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	4.513	874	relative claim charge (+0.85), or (+0.78), n distinct rev codes (+0.77)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	4.157	726	relative claim charge (+0.77), organ system count (+0.76), n distinct hcps (+0.63)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	3.988	1323	relative claim charge (+0.79), icu (+0.60), organ system count (+0.47)
0B9F8ZX	DRAINAGE OF RIGHT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	3.674	900	multiple or days (+0.96), or (+0.58), n distinct rev codes (+0.42)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	3.637	4522	n distinct hcps (+0.94), organ system count (+0.58), icu (+0.57)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	3.627	768	length of stay (+0.85), relative claim charge (+0.66), work rvu (+0.60)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.452	5166	relative claim charge (+0.53), n distinct rev codes (+0.43), organ system count (+0.42)

Key Driver Frequency

feature	count	pct
n distinct rev codes	33	58.900
relative claim charge	27	48.200
or	24	42.900
organ system count	17	30.400
n imaging lines	16	28.600
icu	9	16.100
n distinct hcps	9	16.100
length of stay	9	16.100
multiple or days	8	14.300
work rvu	7	12.500
transfusion	3	5.400
mechanical ventilation	3	5.400
n j code lines	2	3.600
dialysis	1	1.800