OP - CA.0.cardiac_catheterization

CM Codes

Data Overview

7688 total codes in komodo_rii; 266 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	207
CC	50
MCC	9

PCA Analysis

PC1 explains 23.7% of variance; PC1+PC2 together explain 38.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	relative claim charge	n j code lines	organ system count	n imaging lines	n distinct hcps	or
1	180.000	2779641.000	6.907	7.837	1.006	4.795	3.192	0.032	0.700	0.011
2	68.000	309371.000	7.389	8.170	1.049	4.861	3.284	0.058	0.682	0.014
3	18.000	31161.000	9.050	9.164	1.164	4.945	3.173	0.067	0.667	0.028

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	35	8	7	50
MCC	3	5	1	9
No CC/MCC	142	55	10	207
All	180	68	18	266

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.525	-0.238	0.215
avg_relative_claim_charge	0.520	-0.140	0.078
avg_n_distinct_rev_codes	0.508	-0.189	0.057
avg_n_imaging_lines	0.268	-0.117	-0.154
rate_or	0.235	-0.158	-0.153
avg_n_j_code_lines	0.189	-0.093	-0.137
rate_icu	0.138	0.308	-0.016
rate_transfusion	0.051	0.000	0.153
rate_mechanical_ventilation	0.050	-0.032	0.270
rate_dialysis	0.042	0.033	0.159
avg_organ_system_count	0.028	-0.209	-0.250
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_n_distinct_hcps	-0.082	-0.167	-0.099

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
I701	Atherosclerosis of renal artery	No CC/MCC	7.373	3	1349	or (+3.07), relative claim charge (+1.80), work rvu (+1.47)
D84821	Immunodeficiency due to drugs	No CC/MCC	6.495	3	2059	n distinct rev codes (+2.38), work rvu (+2.22), relative claim charge (+2.07)
I708	Atherosclerosis of other arteries	No CC/MCC	5.872	3	1195	relative claim charge (+2.65), work rvu (+1.26), or (+1.26)
I160	Hypertensive urgency	No CC/MCC	4.460	3	768	n distinct rev codes (+1.27), n j code lines (+0.81), n imaging lines (+0.62)
E8342	Hypomagnesemia	No CC/MCC	4.162	3	1263	n distinct rev codes (+1.70), relative claim charge (+1.23), work rvu (+1.06)

Under-tiered: Tier 1, MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I5021	Acute systolic (congestive) heart failure	MCC	-0.886	1	3347	relative claim charge (-0.41), n distinct rev codes (-0.24), n imaging lines (-0.24)
N186	End stage renal disease	MCC	-0.657	1	12600	relative claim charge (-0.32), n j code lines (-0.27), dialysis (+0.23)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	-0.258	1	2888	n j code lines (-0.19), n imaging lines (-0.13), n distinct hcps (+0.10)

Top Codes by Tier

Tier 1 (n=180 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	0.011	10022	n imaging lines (+0.18), work rvu (-0.17), n j code lines (+0.07)
I4510	Unspecified right bundle-branch block	No CC/MCC	0.001	11138	n distinct rev codes (+0.34), n imaging lines (-0.07), relative claim charge (-0.07)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	-0.017	33438	n distinct rev codes (+0.16), work rvu (-0.09), relative claim charge (-0.06)
F418	Other specified anxiety disorders	No CC/MCC	-0.028	1181	n j code lines (+0.21), work rvu (-0.20), relative claim charge (-0.17)
I25710	Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris	CC	-0.053	1160	n j code lines (-0.39), n distinct rev codes (+0.32), n imaging lines (-0.28)
F0390	Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety	No CC/MCC	-0.067	1013	relative claim charge (-0.33), n distinct rev codes (+0.30), n imaging lines (+0.15)
I350	Nonrheumatic aortic (valve) stenosis	No CC/MCC	-0.078	69893	n imaging lines (+0.70), relative claim charge (-0.20), n distinct rev codes (-0.18)
I253	Aneurysm of heart	CC	-0.099	741	n distinct rev codes (+0.17), n j code lines (-0.13), work rvu (-0.09)
I444	Left anterior fascicular block	No CC/MCC	-0.104	2097	n distinct rev codes (+0.68), relative claim charge (-0.30), work rvu (-0.26)
I452	Bifascicular block	CC	-0.114	2687	icu (+0.45), relative claim charge (-0.39), n distinct rev codes (+0.31)

Tier 2 (n=68 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I70213	Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs	No CC/MCC	2.665	2449	relative claim charge (+1.54), or (+0.85), work rvu (+0.76)
I342	Nonrheumatic mitral (valve) stenosis	No CC/MCC	2.545	1229	relative claim charge (+0.64), work rvu (+0.62), n imaging lines (+0.59)
E871	Hypo-osmolality and hyponatremia	CC	2.480	1036	n distinct rev codes (+0.65), icu (+0.53), n j code lines (+0.49)
I3481	Nonrheumatic mitral (valve) annulus calcification	No CC/MCC	2.449	1567	n imaging lines (+0.83), n distinct rev codes (+0.76), work rvu (+0.31)
I083	Combined rheumatic disorders of mitral, aortic and tricuspid valves	No CC/MCC	2.239	6351	relative claim charge (+0.66), work rvu (+0.56), n imaging lines (+0.49)
I6523	Occlusion and stenosis of bilateral carotid arteries	No CC/MCC	2.052	12899	n imaging lines (+0.77), n distinct rev codes (+0.73), relative claim charge (+0.49)
E876	Hypokalemia	No CC/MCC	2.036	2018	n distinct rev codes (+1.03), n j code lines (+0.43), n imaging lines (+0.34)
I361	Nonrheumatic tricuspid (valve) insufficiency	No CC/MCC	1.947	4122	n distinct rev codes (+1.20), work rvu (+0.56), relative claim charge (+0.27)
I071	Rheumatic tricuspid insufficiency	No CC/MCC	1.815	4137	relative claim charge (+0.61), work rvu (+0.56), n distinct rev codes (+0.48)
I6522	Occlusion and stenosis of left carotid artery	No CC/MCC	1.809	1695	n imaging lines (+0.77), relative claim charge (+0.46), n distinct rev codes (+0.43)

Tier 3 (n=18 codes)

code	Description	CMS severity	Score	N claims	Key drivers
T8621	Heart transplant rejection	CC	12.367	975	work rvu (+5.82), relative claim charge (+3.74), n distinct rev codes (+3.01)
I701	Atherosclerosis of renal artery	No CC/MCC	7.373	1349	or (+3.07), relative claim charge (+1.80), work rvu (+1.47)
D84821	Immunodeficiency due to drugs	No CC/MCC	6.495	2059	n distinct rev codes (+2.38), work rvu (+2.22), relative claim charge (+2.07)
I708	Atherosclerosis of other arteries	No CC/MCC	5.872	1195	relative claim charge (+2.65), work rvu (+1.26), or (+1.26)
D849	Immunodeficiency, unspecified	CC	5.599	757	n distinct rev codes (+2.72), work rvu (+1.75), relative claim charge (+1.73)
T86290	Cardiac allograft vasculopathy	CC	4.732	733	n distinct rev codes (+1.90), work rvu (+1.74), relative claim charge (+1.38)
I160	Hypertensive urgency	No CC/MCC	4.460	768	n distinct rev codes (+1.27), n j code lines (+0.81), n imaging lines (+0.62)
E8342	Hypomagnesemia	No CC/MCC	4.162	1263	n distinct rev codes (+1.70), relative claim charge (+1.23), work rvu (+1.06)
I25811	Atherosclerosis of native coronary artery of transplanted heart without angina pectoris	CC	4.027	2044	work rvu (+1.95), relative claim charge (+1.55), n distinct rev codes (+1.35)
I70203	Unspecified atherosclerosis of native arteries of extremities, bilateral legs	No CC/MCC	3.922	829	relative claim charge (+1.94), or (+1.02), work rvu (+0.80)

Key Driver Frequency

feature	count	pct
relative claim charge	197	74.100
n distinct rev codes	187	70.300
work rvu	180	67.700
n imaging lines	104	39.100
n j code lines	67	25.200
or	21	7.900
icu	15	5.600
n distinct hcps	13	4.900
transfusion	8	3.000
dialysis	4	1.500
organ system count	1	0.400
mechanical ventilation	1	0.400

PCS Codes

Data Overview

137 total codes in komodo_rii; 7 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 63.3% of variance; PC1+PC2 together explain 81.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	n j code lines	n distinct hcps	organ system count	work rvu	relative claim charge	n imaging lines	icu
1	3.000	5622.000	11.397	3.563	0.976	1.964	7.000	1.026	0.040	0.019
2	3.000	3747.000	11.340	3.508	0.994	1.886	6.892	1.023	0.032	0.008
3	1.000	832.000	5.498	4.917	0.361	2.279	6.734	1.072	0.014	0.000

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
rate_or	0.361	-0.393
avg_n_j_code_lines	0.359	0.357
avg_relative_claim_charge	0.326	0.286
avg_organ_system_count	0.324	0.071
avg_length_of_stay	0.000	nan
rate_dialysis	0.000	nan
rate_multiple_or_days	-0.000	nan
rate_mechanical_ventilation	-0.145	0.749
rate_icu	-0.198	0.757
rate_transfusion	-0.237	-0.180
avg_work_rvu	-0.255	0.500
avg_n_imaging_lines	-0.258	0.893
avg_n_distinct_hcps	-0.374	-0.321
avg_n_distinct_rev_codes	-0.377	0.179

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=3 codes)

code	Description	Score	N claims	Key drivers
B215YZZ	FLUOROSCOPY OF LEFT HEART USING OTHER CONTRAST	-1.123	817	relative claim charge (-0.33), transfusion (-0.29), n j code lines (-0.29)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	-1.385	2724	n imaging lines (-0.28), icu (-0.22), or (-0.16)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-1.473	2081	work rvu (-0.37), n imaging lines (-0.37), icu (-0.35)

Tier 2 (n=3 codes)

code	Description	Score	N claims	Key drivers
B3101ZZ	FLUOROSCOPY OF THORACIC AORTA USING LOW OSMOLAR CONTRAST	-0.621	1031	organ system count (-0.41), transfusion (+0.33), icu (+0.22)
B2151ZZ	FLUOROSCOPY OF LEFT HEART USING LOW OSMOLAR CONTRAST	-0.810	1832	work rvu (+0.33), or (-0.25), mechanical ventilation (-0.22)
B211YZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING OTHER CONTRAST	-1.017	884	relative claim charge (-0.29), n j code lines (-0.27), transfusion (-0.24)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
4A02X4A	MEASUREMENT OF CARDIAC ELECTRICAL ACTIVITY, GUIDANCE, EXTERNAL APPROACH	6.428	832	n distinct rev codes (+0.92), n distinct hcps (+0.91), or (+0.86)

Key Driver Frequency

feature	count	pct
icu	3	42.900
or	3	42.900
transfusion	3	42.900
work rvu	2	28.600
n imaging lines	2	28.600
relative claim charge	2	28.600
n j code lines	2	28.600
n distinct rev codes	1	14.300
n distinct hcps	1	14.300
organ system count	1	14.300
mechanical ventilation	1	14.300