IP - PU.1.ventilator_under_96

CM Codes

Data Overview

9899 total codes in komodo_rii; 235 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	119
CC	71
MCC	45

PCA Analysis

PC1 explains 35.3% of variance; PC1+PC2 together explain 51.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	n imaging lines	n j code lines	relative claim charge	work rvu	transfusion
1	26.000	25646.000	17.583	6.082	5.034	0.894	0.581	0.877	0.570	0.054
2	147.000	564059.000	20.744	8.226	5.962	1.217	0.666	1.050	0.661	0.114
3	62.000	98831.000	21.932	9.926	5.920	1.295	0.938	1.226	0.878	0.202

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	6	39	26	71
MCC	5	23	17	45
No CC/MCC	15	85	19	119
All	26	147	62	235

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
rate_or	0.409	0.025	0.240
avg_n_distinct_rev_codes	0.397	0.037	0.179
avg_relative_claim_charge	0.387	0.016	0.343
avg_length_of_stay	0.353	0.053	0.254
rate_transfusion	0.349	0.075	0.338
rate_multiple_or_days	0.297	0.024	0.037
avg_n_j_code_lines	0.232	0.079	0.060
avg_n_imaging_lines	0.228	-0.014	0.031
avg_work_rvu	0.209	0.079	0.045
avg_organ_system_count	0.151	0.019	-0.601
rate_dialysis	0.123	0.230	0.250
rate_icu	0.053	0.043	-0.253
rate_mechanical_ventilation	-0.000	nan	nan
avg_n_distinct_hcps	-0.006	-0.174	-0.603

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
D84821	Immunodeficiency due to drugs	No CC/MCC	8.305	3	751	n j code lines (+1.93), multiple or days (+1.76), work rvu (+1.12)
E8770	Fluid overload, unspecified	No CC/MCC	2.925	3	1069	work rvu (+0.85), n j code lines (+0.48), dialysis (+0.32)
J8410	Pulmonary fibrosis, unspecified	No CC/MCC	2.657	3	621	n j code lines (+1.02), or (+0.50), multiple or days (+0.40)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	2.559	3	1155	n distinct rev codes (+0.62), length of stay (+0.47), relative claim charge (+0.33)
D631	Anemia in chronic kidney disease	No CC/MCC	2.459	3	3356	transfusion (+0.57), dialysis (+0.46), n distinct rev codes (+0.40)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G800	Spastic quadriplegic cerebral palsy	MCC	-4.978	1	518	n distinct rev codes (-1.62), or (-0.79), n imaging lines (-0.75)
J9620	Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-4.712	1	881	n distinct rev codes (-1.26), or (-1.08), n imaging lines (-0.64)
G8250	Quadriplegia, unspecified	MCC	-4.248	1	589	n distinct rev codes (-1.13), or (-0.50), relative claim charge (-0.44)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-2.933	1	4358	relative claim charge (-0.75), n distinct rev codes (-0.61), or (-0.55)
J9691	Respiratory failure, unspecified with hypoxia	MCC	-2.375	1	633	relative claim charge (-0.55), length of stay (-0.44), n distinct rev codes (-0.43)

Top Codes by Tier

Tier 1 (n=26 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F4310	Post-traumatic stress disorder, unspecified	No CC/MCC	-2.181	717	relative claim charge (-0.52), length of stay (-0.50), or (-0.42)
F1510	Other stimulant abuse, uncomplicated	No CC/MCC	-2.315	919	relative claim charge (-0.64), length of stay (-0.56), n distinct rev codes (-0.44)
G40909	Epilepsy, unspecified, not intractable, without status epilepticus	No CC/MCC	-2.362	3151	or (-0.48), relative claim charge (-0.38), multiple or days (-0.31)
J9691	Respiratory failure, unspecified with hypoxia	MCC	-2.375	633	relative claim charge (-0.55), length of stay (-0.44), n distinct rev codes (-0.43)
F1410	Cocaine abuse, uncomplicated	No CC/MCC	-2.445	863	relative claim charge (-0.62), or (-0.58), length of stay (-0.48)
F1910	Other psychoactive substance abuse, uncomplicated	No CC/MCC	-2.567	559	relative claim charge (-0.74), length of stay (-0.53), or (-0.51)
J398	Other specified diseases of upper respiratory tract	No CC/MCC	-2.579	533	n distinct rev codes (-0.79), or (+0.57), relative claim charge (-0.45)
G40901	Epilepsy, unspecified, not intractable, with status epilepticus	No CC/MCC	-2.688	1187	or (-0.65), relative claim charge (-0.60), length of stay (-0.49)
J101	Influenza due to other identified influenza virus with other respiratory manifestations	No CC/MCC	-2.849	761	n distinct rev codes (-0.44), transfusion (-0.34), or (-0.33)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-2.933	4358	relative claim charge (-0.75), n distinct rev codes (-0.61), or (-0.55)

Tier 2 (n=147 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E874	Mixed disorder of acid-base balance	CC	1.045	4278	relative claim charge (+0.30), multiple or days (+0.24), n j code lines (+0.18)
E871	Hypo-osmolality and hyponatremia	CC	1.033	8172	n distinct rev codes (+0.24), or (+0.21), relative claim charge (+0.20)
J1282	Pneumonia due to coronavirus disease 2019	No CC/MCC	1.012	2764	relative claim charge (+0.59), length of stay (+0.28), organ system count (-0.18)
J9811	Atelectasis	CC	1.007	4781	or (+0.22), relative claim charge (+0.22), length of stay (+0.21)
I480	Paroxysmal atrial fibrillation	No CC/MCC	0.974	4037	length of stay (+0.21), work rvu (+0.17), n distinct rev codes (+0.14)
K5900	Constipation, unspecified	No CC/MCC	0.924	1665	length of stay (+0.33), organ system count (+0.23), multiple or days (+0.22)
E8351	Hypocalcemia	No CC/MCC	0.900	1290	n distinct rev codes (+0.29), transfusion (+0.23), relative claim charge (+0.17)
E873	Alkalosis	CC	0.900	2807	relative claim charge (+0.40), length of stay (+0.34), n distinct rev codes (+0.15)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	0.891	3057	dialysis (+0.83), transfusion (+0.49), multiple or days (-0.31)
E875	Hyperkalemia	No CC/MCC	0.834	4619	multiple or days (+0.20), organ system count (+0.17), dialysis (+0.16)

Tier 3 (n=62 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D84821	Immunodeficiency due to drugs	No CC/MCC	8.305	751	n j code lines (+1.93), multiple or days (+1.76), work rvu (+1.12)
D61818	Other pancytopenia	CC	6.128	887	transfusion (+1.43), or (+1.01), multiple or days (+0.93)
D62	Acute posthemorrhagic anemia	CC	5.816	2699	transfusion (+2.48), or (+0.94), n distinct rev codes (+0.73)
J918	Pleural effusion in other conditions classified elsewhere	CC	5.410	897	or (+1.53), relative claim charge (+1.05), n distinct rev codes (+0.81)
J910	Malignant pleural effusion	CC	5.136	538	or (+1.71), multiple or days (+1.06), work rvu (+0.59)
B370	Candidal stomatitis	CC	4.709	568	length of stay (+1.39), relative claim charge (+1.19), multiple or days (+0.53)
N170	Acute kidney failure with tubular necrosis	MCC	4.081	4183	relative claim charge (+0.84), or (+0.79), transfusion (+0.76)
E222	Syndrome of inappropriate secretion of antidiuretic hormone	CC	3.702	615	relative claim charge (+0.85), length of stay (+0.80), n j code lines (+0.75)
J150	Pneumonia due to Klebsiella pneumoniae	MCC	3.432	602	relative claim charge (+1.08), length of stay (+0.84), work rvu (+0.35)
A419	Sepsis, unspecified organism	MCC	3.379	7729	or (+0.77), relative claim charge (+0.66), n distinct rev codes (+0.39)

Key Driver Frequency

feature	count	pct
relative claim charge	124	52.800
or	103	43.800
n distinct rev codes	93	39.600
length of stay	78	33.200
multiple or days	76	32.300
transfusion	71	30.200
n j code lines	39	16.600
work rvu	39	16.600
organ system count	37	15.700
n imaging lines	37	15.700
dialysis	8	3.400

PCS Codes

Data Overview

2105 total codes in komodo_rii; 61 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 34.3% of variance; PC1+PC2 together explain 50.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	n j code lines	work rvu	organ system count	relative claim charge	n imaging lines	or
1	25.000	180200.000	8.307	20.888	0.690	0.568	5.147	1.139	1.201	0.348
2	25.000	62449.000	9.452	22.395	1.048	0.797	5.350	1.286	1.414	0.430
3	11.000	12398.000	11.929	24.463	1.263	0.992	5.515	1.502	1.446	0.564

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.388	-0.254
avg_relative_claim_charge	0.356	-0.174
rate_multiple_or_days	0.345	0.052
avg_length_of_stay	0.319	-0.124
rate_or	0.314	-0.184
avg_work_rvu	0.291	0.073
avg_n_j_code_lines	0.279	0.109
avg_organ_system_count	0.278	-0.242
rate_transfusion	0.241	0.126
rate_icu	0.226	-0.268
avg_n_imaging_lines	0.202	-0.151
rate_dialysis	0.098	0.079
avg_n_distinct_hcps	0.070	-0.036
rate_mechanical_ventilation	-0.000	nan

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=25 codes)

code	Description	Score	N claims	Key drivers
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.773	1592	n distinct rev codes (+0.55), n j code lines (-0.33), work rvu (-0.30)
06HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT FEMORAL VEIN, PERCUTANEOUS APPROACH	-0.858	613	multiple or days (-0.33), length of stay (-0.28), n distinct rev codes (-0.22)
05HN33Z	INSERTION OF INFUSION DEVICE INTO LEFT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	-1.009	510	work rvu (-0.47), multiple or days (-0.29), n j code lines (-0.26)
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	-1.014	1704	work rvu (+0.34), organ system count (-0.32), icu (-0.32)
B2151ZZ	FLUOROSCOPY OF LEFT HEART USING LOW OSMOLAR CONTRAST	-1.042	639	n distinct rev codes (+0.54), n j code lines (-0.43), multiple or days (-0.33)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	-1.084	1342	n distinct rev codes (+0.53), n j code lines (-0.29), or (-0.25)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.195	2118	or (-0.26), work rvu (-0.24), organ system count (-0.23)
3E0333Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.288	582	multiple or days (-0.32), or (-0.28), n j code lines (+0.26)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	-1.297	1155	multiple or days (-0.32), relative claim charge (-0.22), icu (-0.17)
04HY32Z	INSERTION OF MONITORING DEVICE INTO LOWER ARTERY, PERCUTANEOUS APPROACH	-1.517	1575	length of stay (-0.39), multiple or days (-0.37), icu (-0.36)

Tier 2 (n=25 codes)

code	Description	Score	N claims	Key drivers
4A133R1	MONITORING OF ARTERIAL SATURATION, PERIPHERAL, PERCUTANEOUS APPROACH	1.703	558	multiple or days (+1.28), n j code lines (+0.63), work rvu (+0.40)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	1.567	880	relative claim charge (+0.38), n distinct rev codes (+0.35), or (+0.32)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	1.440	2782	work rvu (+0.68), n j code lines (+0.45), icu (+0.31)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	1.433	1308	n distinct rev codes (+0.62), or (+0.59), length of stay (+0.37)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	1.216	1564	n j code lines (+0.48), work rvu (+0.39), multiple or days (+0.28)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	1.009	861	multiple or days (+0.46), work rvu (+0.34), organ system count (+0.27)
0W9930Z	DRAINAGE OF RIGHT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	0.905	1767	organ system count (-0.39), multiple or days (+0.29), or (+0.24)
0BJ08ZZ	INSPECTION OF TRACHEOBRONCHIAL TREE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.874	2213	or (+0.54), n j code lines (+0.46), multiple or days (+0.26)
4A133J1	MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH	0.772	1948	organ system count (+0.29), work rvu (+0.28), n j code lines (+0.24)
B548ZZA	ULTRASONOGRAPHY OF SUPERIOR VENA CAVA, GUIDANCE	0.765	1779	n j code lines (+0.26), or (+0.19), multiple or days (+0.12)

Tier 3 (n=11 codes)

code	Description	Score	N claims	Key drivers
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	6.911	701	length of stay (+1.59), relative claim charge (+1.24), n distinct rev codes (+0.99)
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	4.619	596	organ system count (+0.76), n j code lines (+0.60), relative claim charge (+0.59)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.290	3231	transfusion (+1.43), n distinct rev codes (+0.40), multiple or days (+0.38)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	3.055	821	multiple or days (+0.93), or (+0.72), n distinct rev codes (+0.69)
0B9G8ZX	DRAINAGE OF LEFT UPPER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	3.021	527	multiple or days (+0.68), or (+0.56), n distinct rev codes (+0.54)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.017	892	transfusion (+0.62), n distinct rev codes (+0.61), organ system count (+0.57)
0B9J8ZX	DRAINAGE OF LEFT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.734	1279	n j code lines (+0.52), or (+0.51), multiple or days (+0.48)
4A00X4Z	MEASUREMENT OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	2.478	610	work rvu (+0.88), n j code lines (+0.85), n imaging lines (+0.58)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.230	1452	or (+0.51), n distinct rev codes (+0.42), relative claim charge (+0.31)
0B9C8ZX	DRAINAGE OF RIGHT UPPER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.030	683	or (+0.51), multiple or days (+0.41), n distinct rev codes (+0.40)

Key Driver Frequency

feature	count	pct
or	27	44.300
n distinct rev codes	27	44.300
multiple or days	23	37.700
work rvu	21	34.400
n j code lines	18	29.500
organ system count	17	27.900
relative claim charge	17	27.900
icu	13	21.300
length of stay	10	16.400
n imaging lines	6	9.800
transfusion	2	3.300
dialysis	1	1.600
n distinct hcps	1	1.600