OP - CO.0.IV_push

CM Codes

Data Overview

21943 total codes in komodo_rii; 340 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	245
CC	85
MCC	10

PCA Analysis

PC1 explains 24.6% of variance; PC1+PC2 together explain 45.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	relative claim charge	organ system count	n j code lines	n distinct rev codes	n distinct hcps	n imaging lines	dialysis
1	127.000	1469475.000	1.500	1.036	1.950	2.777	2.812	0.386	0.013	0.001
2	203.000	2661752.000	4.047	1.262	2.728	2.712	2.523	0.174	0.064	0.002
3	10.000	51963.000	5.957	2.258	2.740	3.414	3.091	0.125	0.174	0.011

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	52	31	2	85
MCC	3	5	2	10
No CC/MCC	72	167	6	245
All	127	203	10	340

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.472	0.015	-0.279
avg_n_imaging_lines	0.395	-0.024	-0.256
avg_relative_claim_charge	0.370	-0.073	-0.042
avg_organ_system_count	0.316	0.005	-0.189
rate_icu	0.267	0.032	0.072
rate_mechanical_ventilation	0.217	0.245	-0.068
rate_or	0.143	-0.085	0.110
avg_n_j_code_lines	0.121	-0.045	0.148
rate_dialysis	0.116	0.034	-0.012
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
avg_n_distinct_rev_codes	-0.030	-0.040	0.101
rate_transfusion	-0.038	-0.026	0.195
avg_n_distinct_hcps	-0.464	-0.029	0.123

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
S0181XA	Laceration without foreign body of other part of head, initial encounter	No CC/MCC	5.132	3	2824	n imaging lines (+2.21), work rvu (+1.41), relative claim charge (+1.25)
E8720	Acidosis, unspecified	No CC/MCC	4.880	3	5795	icu (+1.36), mechanical ventilation (+0.86), relative claim charge (+0.79)
S0083XA	Contusion of other part of head, initial encounter	No CC/MCC	4.698	3	2863	n imaging lines (+2.70), relative claim charge (+1.05), work rvu (+1.00)
S0990XA	Unspecified injury of head, initial encounter	No CC/MCC	4.529	3	11578	n imaging lines (+2.64), relative claim charge (+0.91), work rvu (+0.88)
G35	None	No CC/MCC	3.341	3	9400	relative claim charge (+3.94), n distinct hcps (+0.44), work rvu (-0.38)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D5700	Hb-SS disease with crisis, unspecified	MCC	-2.119	1	24355	n distinct hcps (-0.88), work rvu (-0.51), or (+0.38)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	-1.856	1	4558	work rvu (-0.52), n distinct hcps (-0.46), relative claim charge (-0.40)
I5033	Acute on chronic diastolic (congestive) heart failure	MCC	-1.751	1	6927	work rvu (-0.60), n distinct hcps (-0.48), relative claim charge (-0.42)

Top Codes by Tier

Tier 1 (n=127 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E559	Vitamin D deficiency, unspecified	No CC/MCC	-0.463	7240	n distinct hcps (-0.57), organ system count (+0.40), work rvu (-0.25)
I255	Ischemic cardiomyopathy	No CC/MCC	-0.473	2701	icu (+0.54), n distinct hcps (-0.38), relative claim charge (-0.35)
J069	Acute upper respiratory infection, unspecified	No CC/MCC	-0.487	14339	n imaging lines (-0.14), icu (-0.12), organ system count (-0.12)
N939	Abnormal uterine and vaginal bleeding, unspecified	No CC/MCC	-0.488	10766	work rvu (+0.31), relative claim charge (-0.24), n imaging lines (-0.23)
B349	Viral infection, unspecified	No CC/MCC	-0.490	19706	n distinct hcps (+0.27), n imaging lines (-0.20), organ system count (-0.17)
A084	Viral intestinal infection, unspecified	No CC/MCC	-0.522	10620	n distinct hcps (+0.32), relative claim charge (-0.25), organ system count (-0.23)
I951	Orthostatic hypotension	No CC/MCC	-0.524	2948	relative claim charge (-0.35), organ system count (+0.25), n distinct hcps (-0.24)
C9100	Acute lymphoblastic leukemia not having achieved remission	CC	-0.548	5147	work rvu (-0.49), relative claim charge (+0.37), n imaging lines (-0.35)
C7989	Secondary malignant neoplasm of other specified sites	CC	-0.554	5732	work rvu (-0.60), relative claim charge (+0.49), n imaging lines (-0.30)
I509	Heart failure, unspecified	No CC/MCC	-0.559	27416	relative claim charge (-0.21), work rvu (-0.14), organ system count (+0.14)

Tier 2 (n=203 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M48061	Spinal stenosis, lumbar region without neurogenic claudication	No CC/MCC	2.790	3173	work rvu (+0.79), n imaging lines (+0.64), relative claim charge (+0.59)
S060X0A	Concussion without loss of consciousness, initial encounter	No CC/MCC	2.603	2672	n imaging lines (+1.40), work rvu (+0.71), relative claim charge (+0.57)
M542	Cervicalgia	No CC/MCC	2.601	23866	n imaging lines (+1.39), work rvu (+0.65), relative claim charge (+0.49)
N186	End stage renal disease	MCC	2.525	10045	dialysis (+1.24), organ system count (+0.56), icu (+0.36)
E875	Hyperkalemia	No CC/MCC	2.504	5222	icu (+1.05), dialysis (+0.61), organ system count (+0.49)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	2.414	5451	dialysis (+0.76), organ system count (+0.62), icu (+0.45)
N179	Acute kidney failure, unspecified	CC	2.317	18867	icu (+0.71), organ system count (+0.46), n distinct hcps (+0.36)
F4310	Post-traumatic stress disorder, unspecified	No CC/MCC	2.227	3527	work rvu (+0.51), organ system count (+0.43), mechanical ventilation (+0.35)
J439	Emphysema, unspecified	No CC/MCC	2.131	3738	organ system count (+0.61), n imaging lines (+0.41), n distinct hcps (+0.40)
F0390	Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety	No CC/MCC	2.127	2820	n imaging lines (+1.02), organ system count (+0.61), n distinct hcps (+0.40)

Tier 3 (n=10 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9601	Acute respiratory failure with hypoxia	MCC	8.765	3002	mechanical ventilation (+3.48), icu (+2.72), organ system count (+0.66)
K3580	Unspecified acute appendicitis	CC	8.515	3831	work rvu (+3.11), relative claim charge (+2.27), or (+1.93)
S0181XA	Laceration without foreign body of other part of head, initial encounter	No CC/MCC	5.132	2824	n imaging lines (+2.21), work rvu (+1.41), relative claim charge (+1.25)
E8720	Acidosis, unspecified	No CC/MCC	4.880	5795	icu (+1.36), mechanical ventilation (+0.86), relative claim charge (+0.79)
S0083XA	Contusion of other part of head, initial encounter	No CC/MCC	4.698	2863	n imaging lines (+2.70), relative claim charge (+1.05), work rvu (+1.00)
S0990XA	Unspecified injury of head, initial encounter	No CC/MCC	4.529	11578	n imaging lines (+2.64), relative claim charge (+0.91), work rvu (+0.88)
G35	None	No CC/MCC	3.341	9400	relative claim charge (+3.94), n distinct hcps (+0.44), work rvu (-0.38)
S161XXA	Strain of muscle, fascia and tendon at neck level, initial encounter	No CC/MCC	3.240	5315	n imaging lines (+1.70), work rvu (+0.95), relative claim charge (+0.62)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.168	2851	dialysis (+1.32), organ system count (+0.78), icu (+0.54)
A419	Sepsis, unspecified organism	MCC	3.069	4504	icu (+1.47), mechanical ventilation (+1.15), organ system count (+0.37)

Key Driver Frequency

feature	count	pct
work rvu	259	76.200
n distinct hcps	228	67.100
organ system count	155	45.600
n imaging lines	139	40.900
relative claim charge	130	38.200
icu	67	19.700
n j code lines	13	3.800
mechanical ventilation	11	3.200
or	11	3.200
dialysis	5	1.500
transfusion	2	0.600