OP - CA.0.pacemaker_insertion

CM Codes

Data Overview

2999 total codes in komodo_rii; 75 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	55
CC	20

PCA Analysis

PC1 explains 31.7% of variance; PC1+PC2 together explain 46.3%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	organ system count	n j code lines	n distinct rev codes	relative claim charge	n distinct hcps	or	transfusion
1	50.000	183793.000	11.160	3.003	5.709	10.023	0.994	0.669	0.434	0.001
2	19.000	42507.000	12.644	3.069	5.948	10.181	1.082	0.645	0.402	0.001
3	6.000	7624.000	16.076	2.609	6.138	10.444	1.303	0.618	0.422	0.003

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	7	8	5	20
No CC/MCC	43	11	1	55
All	50	19	6	75

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.491	-0.081	0.545
avg_relative_claim_charge	0.485	-0.084	0.368
avg_n_distinct_rev_codes	0.400	-0.329	0.309
avg_n_j_code_lines	0.384	-0.193	0.234
rate_transfusion	0.191	0.249	0.127
rate_icu	0.190	0.354	-0.121
rate_dialysis	0.134	0.161	0.029
avg_n_imaging_lines	0.024	0.208	-0.249
avg_length_of_stay	0.000	nan	nan
rate_mechanical_ventilation	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
avg_organ_system_count	-0.093	-0.091	-0.358
rate_or	-0.153	-0.105	-0.331
avg_n_distinct_hcps	-0.305	-0.036	-0.181

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (1 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I255	Ischemic cardiomyopathy	No CC/MCC	3.226	3	1040	relative claim charge (+0.97), work rvu (+0.91), n distinct rev codes (+0.54)

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

None.

Top Codes by Tier

Tier 1 (n=50 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N1831	Chronic kidney disease, stage 3a	No CC/MCC	-0.038	817	n distinct hcps (+0.45), n j code lines (+0.26), work rvu (-0.26)
I5032	Chronic diastolic (congestive) heart failure	CC	-0.064	2354	relative claim charge (-0.23), n j code lines (+0.18), dialysis (+0.14)
E039	Hypothyroidism, unspecified	No CC/MCC	-0.141	4088	icu (+0.31), work rvu (-0.22), relative claim charge (-0.16)
I491	Atrial premature depolarization	No CC/MCC	-0.213	758	n distinct rev codes (+0.86), relative claim charge (-0.54), work rvu (-0.37)
I4710	Supraventricular tachycardia, unspecified	No CC/MCC	-0.232	1074	n j code lines (+0.34), n distinct rev codes (-0.30), work rvu (-0.28)
I4891	Unspecified atrial fibrillation	No CC/MCC	-0.235	4170	n j code lines (-0.24), transfusion (+0.19), relative claim charge (-0.17)
I4820	Chronic atrial fibrillation, unspecified	CC	-0.388	810	n j code lines (-0.42), or (-0.36), n distinct rev codes (+0.17)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-0.437	6448	n j code lines (-0.38), icu (+0.24), work rvu (-0.22)
N189	Chronic kidney disease, unspecified	No CC/MCC	-0.471	1997	n distinct rev codes (+0.22), work rvu (-0.13), or (-0.12)
I4892	Unspecified atrial flutter	CC	-0.485	2550	n distinct rev codes (-0.24), transfusion (-0.12), work rvu (+0.11)

Tier 2 (n=19 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I4811	Longstanding persistent atrial fibrillation	CC	2.558	865	work rvu (+0.77), n distinct rev codes (+0.65), relative claim charge (+0.52)
I484	Atypical atrial flutter	CC	2.304	805	work rvu (+0.73), n distinct rev codes (+0.63), n j code lines (+0.60)
I447	Left bundle-branch block, unspecified	No CC/MCC	2.141	3374	relative claim charge (+0.77), work rvu (+0.70), dialysis (+0.28)
I081	Rheumatic disorders of both mitral and tricuspid valves	No CC/MCC	2.100	556	n j code lines (+0.64), n distinct rev codes (+0.42), dialysis (+0.39)
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	1.960	2092	n distinct hcps (+0.65), n j code lines (+0.55), n distinct rev codes (+0.43)
I429	Cardiomyopathy, unspecified	CC	1.864	1145	relative claim charge (+0.88), work rvu (+0.77), dialysis (+0.36)
I110	Hypertensive heart disease with heart failure	No CC/MCC	1.725	5401	work rvu (+0.55), relative claim charge (+0.45), icu (+0.30)
I4819	Other persistent atrial fibrillation	CC	1.685	4414	work rvu (+0.54), n distinct hcps (+0.31), n j code lines (+0.24)
I509	Heart failure, unspecified	No CC/MCC	1.562	2005	icu (+0.95), work rvu (+0.26), relative claim charge (+0.23)
F32A	Depression, unspecified	No CC/MCC	0.913	852	icu (+0.53), n j code lines (+0.43), relative claim charge (+0.35)

Tier 3 (n=6 codes)

code	Description	CMS severity	Score	N claims	Key drivers
T82110A	Breakdown (mechanical) of cardiac electrode, initial encounter	CC	7.231	597	work rvu (+1.47), transfusion (+1.39), n distinct rev codes (+1.30)
I5042	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	CC	6.141	666	n distinct rev codes (+1.47), relative claim charge (+1.46), work rvu (+1.29)
I420	Dilated cardiomyopathy	CC	4.406	950	relative claim charge (+1.57), work rvu (+1.36), n distinct hcps (+0.74)
I428	Other cardiomyopathies	CC	4.150	1830	relative claim charge (+1.50), work rvu (+1.44), n j code lines (+0.81)
I5022	Chronic systolic (congestive) heart failure	CC	3.851	2541	work rvu (+1.46), relative claim charge (+1.38), n distinct rev codes (+0.36)
I255	Ischemic cardiomyopathy	No CC/MCC	3.226	1040	relative claim charge (+0.97), work rvu (+0.91), n distinct rev codes (+0.54)

Key Driver Frequency

feature	count	pct
work rvu	44	58.700
relative claim charge	41	54.700
n j code lines	40	53.300
n distinct rev codes	40	53.300
n distinct hcps	29	38.700
or	11	14.700
dialysis	9	12.000
icu	6	8.000
transfusion	4	5.300
n imaging lines	1	1.300