OP - CO.0.op_clinic

CM Codes

Data Overview

49823 total codes in komodo_rii; 432 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	359
CC	67
MCC	6

PCA Analysis

PC1 explains 26.1% of variance; PC1+PC2 together explain 40.6%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	relative claim charge	organ system count	work rvu	n j code lines	n distinct hcps	or	n imaging lines
1	213.000	42515743.000	1.582	0.965	2.367	0.191	0.049	0.746	0.007	0.003
2	208.000	60088576.000	1.943	1.250	2.726	0.221	0.077	0.745	0.003	0.005
3	11.000	1327323.000	2.559	1.756	2.988	0.328	0.139	0.764	0.004	0.003

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	26	36	5	67
MCC	2	4	0	6
No CC/MCC	185	168	6	359
All	213	208	11	432

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.456	0.067	0.235
avg_relative_claim_charge	0.435	0.038	0.111
rate_transfusion	0.407	0.152	0.233
rate_dialysis	0.401	0.275	0.031
rate_icu	0.332	0.251	0.110
avg_n_j_code_lines	0.306	0.092	-0.002
avg_organ_system_count	0.189	0.197	-0.114
avg_work_rvu	0.173	-0.174	-0.005
rate_mechanical_ventilation	0.067	0.073	0.112
avg_n_imaging_lines	0.035	0.090	0.066
avg_n_distinct_hcps	0.011	-0.162	-0.153
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_or	-0.034	-0.029	0.036

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
D469	Myelodysplastic syndrome, unspecified	No CC/MCC	15.718	3	74429	dialysis (+6.07), transfusion (+6.05), n distinct rev codes (+1.54)
D84821	Immunodeficiency due to drugs	No CC/MCC	10.612	3	96880	icu (+5.07), dialysis (+1.59), relative claim charge (+1.24)
T451X5A	Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter	No CC/MCC	7.830	3	150948	transfusion (+1.97), n j code lines (+1.45), icu (+1.12)
E8342	Hypomagnesemia	No CC/MCC	7.359	3	140742	n distinct rev codes (+1.51), relative claim charge (+1.38), icu (+1.22)
D709	Neutropenia, unspecified	No CC/MCC	6.986	3	60113	transfusion (+1.82), dialysis (+1.40), icu (+1.11)

Under-tiered: Tier 1, MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I639	Cerebral infarction, unspecified	MCC	-0.940	1	185005	relative claim charge (-0.32), n distinct rev codes (-0.21), n j code lines (-0.19)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	-0.480	1	190039	n distinct rev codes (+0.23), relative claim charge (-0.20), n j code lines (-0.19)

Top Codes by Tier

Tier 1 (n=213 codes)

code	Description	CMS severity	Score	N claims	Key drivers
L409	Psoriasis, unspecified	No CC/MCC	-0.229	104343	transfusion (-0.10), dialysis (-0.10), icu (-0.08)
M419	Scoliosis, unspecified	No CC/MCC	-0.231	67202	relative claim charge (+0.30), n j code lines (-0.19), n distinct rev codes (-0.17)
E1142	Type 2 diabetes mellitus with diabetic polyneuropathy	No CC/MCC	-0.236	483906	organ system count (+0.20), relative claim charge (-0.15), n j code lines (+0.13)
M159	Polyosteoarthritis, unspecified	No CC/MCC	-0.264	168872	n j code lines (+0.16), work rvu (-0.15), organ system count (+0.13)
G8929	Other chronic pain	No CC/MCC	-0.265	1787045	n distinct rev codes (-0.28), organ system count (+0.21), n j code lines (+0.11)
M5450	Low back pain, unspecified	No CC/MCC	-0.272	1023777	n distinct rev codes (-0.26), n j code lines (+0.10), transfusion (-0.07)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	-0.273	70007	n distinct rev codes (-0.25), n j code lines (+0.22), relative claim charge (-0.19)
J441	Chronic obstructive pulmonary disease with (acute) exacerbation	CC	-0.275	119964	n j code lines (+0.33), relative claim charge (-0.12), n distinct rev codes (-0.11)
J029	Acute pharyngitis, unspecified	No CC/MCC	-0.278	371552	n distinct rev codes (+0.38), organ system count (-0.36), relative claim charge (+0.29)
L989	Disorder of the skin and subcutaneous tissue, unspecified	No CC/MCC	-0.278	165481	n j code lines (+0.31), relative claim charge (-0.23), n distinct rev codes (-0.23)

Tier 2 (n=208 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N179	Acute kidney failure, unspecified	CC	3.883	130050	icu (+0.98), n distinct rev codes (+0.95), relative claim charge (+0.59)
D631	Anemia in chronic kidney disease	No CC/MCC	3.496	241530	dialysis (+0.94), n distinct rev codes (+0.86), relative claim charge (+0.57)
D696	Thrombocytopenia, unspecified	No CC/MCC	3.446	327039	transfusion (+1.65), n distinct rev codes (+0.81), relative claim charge (+0.50)
E876	Hypokalemia	No CC/MCC	3.295	197773	n distinct rev codes (+0.89), n j code lines (+0.68), transfusion (+0.46)
E538	Deficiency of other specified B group vitamins	No CC/MCC	3.195	406330	n j code lines (+1.70), n distinct rev codes (+0.88), relative claim charge (+0.58)
E871	Hypo-osmolality and hyponatremia	CC	3.158	144488	icu (+1.15), n distinct rev codes (+0.61), transfusion (+0.37)
N2581	Secondary hyperparathyroidism of renal origin	CC	2.963	117651	dialysis (+1.45), icu (+0.53), n distinct rev codes (+0.43)
C787	Secondary malignant neoplasm of liver and intrahepatic bile duct	CC	2.919	144315	n j code lines (+1.22), n distinct rev codes (+0.73), work rvu (+0.40)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	2.805	100172	n distinct rev codes (+0.87), relative claim charge (+0.76), icu (+0.62)
D649	Anemia, unspecified	No CC/MCC	2.737	816012	n distinct rev codes (+0.94), relative claim charge (+0.76), transfusion (+0.75)

Tier 3 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D469	Myelodysplastic syndrome, unspecified	No CC/MCC	15.718	74429	dialysis (+6.07), transfusion (+6.05), n distinct rev codes (+1.54)
D84821	Immunodeficiency due to drugs	No CC/MCC	10.612	96880	icu (+5.07), dialysis (+1.59), relative claim charge (+1.24)
D61818	Other pancytopenia	CC	8.747	79487	transfusion (+4.01), dialysis (+1.34), n distinct rev codes (+1.20)
T451X5A	Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter	No CC/MCC	7.830	150948	transfusion (+1.97), n j code lines (+1.45), icu (+1.12)
E8342	Hypomagnesemia	No CC/MCC	7.359	140742	n distinct rev codes (+1.51), relative claim charge (+1.38), icu (+1.22)
D709	Neutropenia, unspecified	No CC/MCC	6.986	60113	transfusion (+1.82), dialysis (+1.40), icu (+1.11)
E875	Hyperkalemia	No CC/MCC	6.604	103836	icu (+2.33), dialysis (+2.05), n distinct rev codes (+0.80)
B20	Human immunodeficiency virus [HIV] disease	CC	6.559	164476	n j code lines (+2.24), n distinct rev codes (+1.92), relative claim charge (+1.90)
D849	Immunodeficiency, unspecified	CC	6.311	185032	relative claim charge (+1.46), n distinct rev codes (+1.22), transfusion (+1.14)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	5.759	69010	dialysis (+3.23), icu (+0.98), relative claim charge (+0.55)

Key Driver Frequency

feature	count	pct
n distinct rev codes	306	70.800
relative claim charge	293	67.800
n j code lines	255	59.000
organ system count	167	38.700
work rvu	122	28.200
icu	49	11.300
dialysis	47	10.900
transfusion	38	8.800
n imaging lines	11	2.500
mechanical ventilation	5	1.200
or	3	0.700