OP - CA.0.ICD_replacement

CM Codes

Data Overview

3138 total codes in komodo_rii; 78 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	53
CC	22
MCC	3

PCA Analysis

PC1 explains 30.7% of variance; PC1+PC2 together explain 46.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n j code lines	organ system count	relative claim charge	n distinct hcps	or	n imaging lines
1	51.000	213201.000	14.027	9.243	5.663	3.151	0.996	0.699	0.418	0.002
2	26.000	141494.000	16.343	9.650	5.842	2.682	1.054	0.658	0.406	0.002
3	1.000	890.000	24.156	10.902	7.207	3.217	1.159	0.559	0.467	0.006

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	10	11	1	22
MCC	1	2	0	3
No CC/MCC	40	13	0	53
All	51	26	1	78

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.475	-0.143	0.093
avg_n_distinct_rev_codes	0.471	-0.252	0.087
avg_relative_claim_charge	0.407	-0.076	0.151
avg_n_j_code_lines	0.357	-0.086	-0.039
rate_icu	0.266	0.402	-0.123
avg_n_imaging_lines	0.178	0.182	0.271
rate_transfusion	0.171	0.030	0.183
rate_mechanical_ventilation	0.101	0.342	-0.082
rate_dialysis	0.075	0.094	-0.000
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_or	-0.003	-0.099	-0.170
avg_organ_system_count	-0.110	-0.220	-0.383
avg_n_distinct_hcps	-0.316	-0.105	-0.245

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (0 codes)

None.

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I4901	Ventricular fibrillation	MCC	-1.501	1	1726	relative claim charge (-0.54), work rvu (-0.43), n distinct rev codes (-0.34)

Top Codes by Tier

Tier 1 (n=51 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	0.192	5335	n distinct hcps (+0.38), n distinct rev codes (+0.23), organ system count (-0.12)
N189	Chronic kidney disease, unspecified	No CC/MCC	0.123	3426	work rvu (-0.21), transfusion (+0.18), n imaging lines (+0.18)
I110	Hypertensive heart disease with heart failure	No CC/MCC	0.120	27028	n distinct hcps (+0.17), n j code lines (-0.15), organ system count (+0.10)
I4729	Other ventricular tachycardia	No CC/MCC	0.092	2494	n j code lines (+0.45), relative claim charge (-0.19), n distinct hcps (-0.19)
I5020	Unspecified systolic (congestive) heart failure	CC	0.060	2866	n imaging lines (+0.29), n distinct hcps (-0.20), n distinct rev codes (-0.17)
I340	Nonrheumatic mitral (valve) insufficiency	No CC/MCC	-0.005	2758	work rvu (+0.17), transfusion (-0.15), n distinct rev codes (+0.15)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	-0.091	24846	icu (+0.26), n j code lines (-0.22), relative claim charge (-0.12)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-0.095	5250	icu (+0.72), n distinct hcps (-0.28), n j code lines (+0.24)
E782	Mixed hyperlipidemia	No CC/MCC	-0.244	3324	icu (+0.56), transfusion (-0.25), relative claim charge (-0.18)
E1142	Type 2 diabetes mellitus with diabetic polyneuropathy	No CC/MCC	-0.284	602	n distinct hcps (+0.46), transfusion (-0.25), n imaging lines (-0.21)

Tier 2 (n=26 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I441	Atrioventricular block, second degree	No CC/MCC	3.864	519	relative claim charge (+1.69), work rvu (+1.43), n distinct rev codes (+0.67)
I452	Bifascicular block	CC	3.408	622	work rvu (+1.14), relative claim charge (+0.93), n distinct rev codes (+0.80)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	3.030	1256	mechanical ventilation (+0.83), work rvu (+0.75), n distinct rev codes (+0.63)
I440	Atrioventricular block, first degree	No CC/MCC	2.648	1111	n distinct rev codes (+1.13), work rvu (+0.84), relative claim charge (+0.44)
I447	Left bundle-branch block, unspecified	No CC/MCC	2.546	13840	relative claim charge (+1.20), work rvu (+0.83), n j code lines (+0.24)
I25119	Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris	No CC/MCC	2.326	552	n imaging lines (+0.82), n distinct hcps (+0.42), n j code lines (+0.37)
I4811	Longstanding persistent atrial fibrillation	CC	1.910	597	n imaging lines (+0.40), transfusion (+0.39), work rvu (+0.35)
I495	Sick sinus syndrome	No CC/MCC	1.712	4048	n distinct hcps (+0.46), work rvu (+0.38), relative claim charge (+0.27)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	1.535	645	n distinct rev codes (+0.61), dialysis (+0.47), n j code lines (-0.46)
I4510	Unspecified right bundle-branch block	No CC/MCC	1.532	1402	n distinct rev codes (+0.79), work rvu (+0.70), n imaging lines (-0.21)

Tier 3 (n=1 codes)

code	Description	CMS severity	Score	N claims	Key drivers
T82110A	Breakdown (mechanical) of cardiac electrode, initial encounter	CC	11.196	890	work rvu (+2.16), n distinct rev codes (+2.11), icu (+1.94)

Key Driver Frequency

feature	count	pct
n distinct rev codes	45	57.700
n j code lines	42	53.800
work rvu	38	48.700
relative claim charge	38	48.700
n distinct hcps	34	43.600
transfusion	11	14.100
n imaging lines	10	12.800
organ system count	8	10.300
icu	5	6.400
dialysis	2	2.600
mechanical ventilation	1	1.300