OP - DE.0.cyst_aspiration

CM Codes

Data Overview

8592 total codes in komodo_rii; 77 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	70
CC	7

PCA Analysis

PC1 explains 43.6% of variance; PC1+PC2 together explain 64.2%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	n distinct rev codes	relative claim charge	organ system count	or	n distinct hcps	n imaging lines
1	48.000	70202.000	2.983	0.942	2.316	0.833	1.607	0.253	0.466	0.020
2	25.000	31713.000	5.342	2.689	3.847	1.668	3.316	0.298	0.439	0.107
3	4.000	3736.000	16.433	9.336	8.001	4.205	2.170	0.768	0.666	0.070

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	7	0	0	7
No CC/MCC	41	25	4	70
All	48	25	4	77

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.439	-0.054	-0.134
avg_n_distinct_rev_codes	0.425	-0.030	-0.124
avg_work_rvu	0.423	-0.146	0.045
avg_n_j_code_lines	0.420	-0.072	-0.055
rate_transfusion	0.313	0.037	0.002
rate_or	0.254	0.070	-0.163
avg_organ_system_count	0.209	-0.162	-0.024
avg_n_imaging_lines	0.204	-0.039	0.051
rate_icu	0.098	-0.151	-0.013
avg_n_distinct_hcps	0.091	0.089	0.012
rate_dialysis	0.080	-0.244	-0.074
avg_length_of_stay	0.000	nan	nan
rate_mechanical_ventilation	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
N838	Other noninflammatory disorders of ovary, fallopian tube and broad ligament	No CC/MCC	7.762	3	685	work rvu (+1.71), relative claim charge (+1.64), n j code lines (+1.57)
N83201	Unspecified ovarian cyst, right side	No CC/MCC	7.630	3	1222	n j code lines (+1.48), relative claim charge (+1.47), work rvu (+1.46)
N736	Female pelvic peritoneal adhesions (postinfective)	No CC/MCC	7.187	3	651	work rvu (+1.68), n j code lines (+1.63), relative claim charge (+1.55)
N83202	Unspecified ovarian cyst, left side	No CC/MCC	6.735	3	1178	relative claim charge (+1.46), n j code lines (+1.42), work rvu (+1.41)

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

None.

Top Codes by Tier

Tier 1 (n=48 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	-0.171	503	transfusion (+0.19), organ system count (+0.14), or (-0.13)
C787	Secondary malignant neoplasm of liver and intrahepatic bile duct	CC	-0.212	593	work rvu (+0.29), or (-0.26), icu (+0.24)
C7951	Secondary malignant neoplasm of bone	CC	-0.435	932	work rvu (+0.28), or (-0.27), n distinct rev codes (-0.18)
C9000	Multiple myeloma not having achieved remission	CC	-0.510	889	n distinct rev codes (-0.33), or (-0.31), work rvu (+0.25)
M533	Sacrococcygeal disorders, not elsewhere classified	No CC/MCC	-0.511	920	relative claim charge (-0.33), work rvu (-0.26), n imaging lines (+0.18)
M899	Disorder of bone, unspecified	No CC/MCC	-0.571	686	or (-0.31), work rvu (+0.24), n distinct rev codes (-0.23)
N610	Mastitis without abscess	No CC/MCC	-0.695	802	n j code lines (-0.34), or (+0.22), work rvu (-0.19)
E041	Nontoxic single thyroid nodule	No CC/MCC	-0.748	812	or (+0.36), n j code lines (-0.33), organ system count (-0.21)
G8929	Other chronic pain	No CC/MCC	-0.777	3085	n distinct rev codes (-0.27), work rvu (-0.18), transfusion (-0.14)
N644	Mastodynia	No CC/MCC	-0.803	1377	n j code lines (-0.34), or (+0.24), work rvu (-0.19)

Tier 2 (n=25 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N281	Cyst of kidney, acquired	No CC/MCC	2.449	1717	n imaging lines (+1.28), n distinct rev codes (+0.83), or (+0.49)
E669	Obesity, unspecified	No CC/MCC	2.380	1060	relative claim charge (+0.71), n j code lines (+0.44), n distinct rev codes (+0.39)
F32A	Depression, unspecified	No CC/MCC	2.197	731	relative claim charge (+0.45), n distinct rev codes (+0.41), organ system count (+0.39)
F419	Anxiety disorder, unspecified	No CC/MCC	2.177	1071	relative claim charge (+0.56), n j code lines (+0.43), n distinct rev codes (+0.41)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	2.085	510	dialysis (+0.40), transfusion (+0.37), icu (+0.30)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	1.960	1911	relative claim charge (+0.44), organ system count (+0.41), n j code lines (+0.34)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	1.944	605	relative claim charge (+0.63), n j code lines (+0.38), n distinct rev codes (+0.33)
D649	Anemia, unspecified	No CC/MCC	1.908	1294	transfusion (+1.18), relative claim charge (+0.51), work rvu (+0.27)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	1.760	554	relative claim charge (+0.50), organ system count (+0.47), icu (+0.26)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	1.736	1376	n distinct rev codes (+0.31), n j code lines (+0.31), organ system count (+0.29)

Tier 3 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N838	Other noninflammatory disorders of ovary, fallopian tube and broad ligament	No CC/MCC	7.762	685	work rvu (+1.71), relative claim charge (+1.64), n j code lines (+1.57)
N83201	Unspecified ovarian cyst, right side	No CC/MCC	7.630	1222	n j code lines (+1.48), relative claim charge (+1.47), work rvu (+1.46)
N736	Female pelvic peritoneal adhesions (postinfective)	No CC/MCC	7.187	651	work rvu (+1.68), n j code lines (+1.63), relative claim charge (+1.55)
N83202	Unspecified ovarian cyst, left side	No CC/MCC	6.735	1178	relative claim charge (+1.46), n j code lines (+1.42), work rvu (+1.41)

Key Driver Frequency

feature	count	pct
work rvu	43	55.800
relative claim charge	37	48.100
n j code lines	37	48.100
n distinct rev codes	32	41.600
or	29	37.700
organ system count	19	24.700
transfusion	12	15.600
n imaging lines	11	14.300
icu	8	10.400
dialysis	3	3.900