OP - EM.0.debridement

CM Codes

Data Overview

16885 total codes in komodo_rii; 420 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	267
CC	129
MCC	24

PCA Analysis

PC1 explains 26.1% of variance; PC1+PC2 together explain 38.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	organ system count	n distinct rev codes	n j code lines	relative claim charge	or	n distinct hcps	work rvu	n imaging lines
1	290.000	4427087.000	3.058	1.727	0.057	1.051	0.367	0.632	1.677	0.001
2	100.000	1210703.000	3.838	1.993	0.216	1.130	0.402	0.630	1.644	0.002
3	30.000	188077.000	4.715	2.375	0.493	1.240	0.435	0.661	1.672	0.004

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	96	30	3	129
MCC	21	3	0	24
No CC/MCC	173	67	27	267
All	290	100	30	420

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.500	-0.111	-0.197
avg_n_j_code_lines	0.471	-0.132	-0.191
avg_organ_system_count	0.423	-0.066	-0.306
rate_transfusion	0.356	0.282	0.063
avg_relative_claim_charge	0.275	-0.032	0.262
avg_n_imaging_lines	0.227	0.046	-0.101
rate_or	0.220	0.020	-0.129
rate_dialysis	0.205	0.262	-0.002
rate_icu	0.052	0.210	-0.007
avg_work_rvu	0.045	-0.147	0.245
avg_n_distinct_hcps	0.018	-0.046	-0.155
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 (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D631	Anemia in chronic kidney disease	No CC/MCC	8.734	3	3265	transfusion (+2.74), dialysis (+1.85), organ system count (+1.33)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	8.166	3	19509	n j code lines (+2.87), n distinct rev codes (+2.24), organ system count (+1.23)
D649	Anemia, unspecified	No CC/MCC	6.918	3	10433	transfusion (+3.30), n j code lines (+0.97), organ system count (+0.94)
L7682	Other postprocedural complications of skin and subcutaneous tissue	No CC/MCC	6.607	3	2073	n j code lines (+3.64), n distinct rev codes (+1.55), relative claim charge (+0.90)
F419	Anxiety disorder, unspecified	No CC/MCC	5.758	3	8839	n j code lines (+1.94), n distinct rev codes (+1.54), organ system count (+1.16)

Under-tiered: Tier 1, MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
L89153	Pressure ulcer of sacral region, stage 3	MCC	-1.933	1	24931	organ system count (-0.51), n distinct rev codes (-0.43), relative claim charge (-0.30)
L89623	Pressure ulcer of left heel, stage 3	MCC	-1.922	1	17629	organ system count (-0.44), n distinct rev codes (-0.39), n j code lines (-0.32)
L89613	Pressure ulcer of right heel, stage 3	MCC	-1.785	1	16055	organ system count (-0.42), n distinct rev codes (-0.42), n j code lines (-0.30)
L89323	Pressure ulcer of left buttock, stage 3	MCC	-1.700	1	13389	organ system count (-0.47), n distinct rev codes (-0.41), n j code lines (-0.28)
L89213	Pressure ulcer of right hip, stage 3	MCC	-1.618	1	3679	organ system count (-0.47), n distinct rev codes (-0.34), or (-0.29)

Top Codes by Tier

Tier 1 (n=290 codes)

code	Description	CMS severity	Score	N claims	Key drivers
S91102A	Unspecified open wound of left great toe without damage to nail, initial encounter	No CC/MCC	0.155	2574	transfusion (+0.32), or (+0.19), n imaging lines (-0.18)
L97526	Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis	CC	0.145	8673	transfusion (+0.30), relative claim charge (+0.17), n j code lines (-0.15)
L97519	Non-pressure chronic ulcer of other part of right foot with unspecified severity	No CC/MCC	0.101	27790	dialysis (+0.30), organ system count (-0.24), relative claim charge (-0.23)
M86672	Other chronic osteomyelitis, left ankle and foot	CC	0.091	8724	organ system count (+0.26), n distinct rev codes (-0.07), dialysis (-0.05)
T148XXA	Other injury of unspecified body region, initial encounter	No CC/MCC	0.086	14452	n distinct rev codes (+0.51), or (-0.15), n j code lines (-0.12)
T8789	Other complications of amputation stump	No CC/MCC	0.080	13188	n j code lines (+0.19), organ system count (+0.14), relative claim charge (-0.09)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	0.062	60781	n distinct rev codes (-0.25), relative claim charge (+0.20), organ system count (+0.17)
L089	Local infection of the skin and subcutaneous tissue, unspecified	No CC/MCC	0.045	29437	n distinct rev codes (+0.29), or (-0.27), relative claim charge (+0.12)
M79604	Pain in right leg	No CC/MCC	0.036	2775	or (-0.46), relative claim charge (+0.28), n imaging lines (+0.26)
E1141	Type 2 diabetes mellitus with diabetic mononeuropathy	No CC/MCC	0.025	1572	dialysis (+1.27), n distinct rev codes (-0.89), or (+0.48)

Tier 2 (n=100 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	2.834	9686	dialysis (+0.81), organ system count (+0.78), n distinct rev codes (+0.62)
F1290	Cannabis use, unspecified, uncomplicated	No CC/MCC	2.827	1606	n j code lines (+1.05), organ system count (+0.81), transfusion (+0.70)
I5042	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	CC	2.758	2404	transfusion (+1.45), dialysis (+0.76), organ system count (+0.45)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	2.749	2016	n j code lines (+0.69), n distinct rev codes (+0.61), organ system count (+0.54)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	2.694	1839	n j code lines (+0.97), organ system count (+0.88), or (+0.49)
E785	Hyperlipidemia, unspecified	No CC/MCC	2.520	61791	n distinct rev codes (+0.91), n j code lines (+0.61), organ system count (+0.58)
L02211	Cutaneous abscess of abdominal wall	CC	2.498	2517	n j code lines (+1.49), n distinct rev codes (+0.66), transfusion (+0.35)
I252	Old myocardial infarction	No CC/MCC	2.445	11943	n distinct rev codes (+0.83), organ system count (+0.60), n j code lines (+0.57)
M7989	Other specified soft tissue disorders	No CC/MCC	2.355	6671	n distinct rev codes (+0.98), n imaging lines (+0.51), n j code lines (+0.42)
L89159	Pressure ulcer of sacral region, unspecified stage	No CC/MCC	2.320	2199	n distinct rev codes (+0.83), or (+0.52), n j code lines (+0.51)

Tier 3 (n=30 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D631	Anemia in chronic kidney disease	No CC/MCC	8.734	3265	transfusion (+2.74), dialysis (+1.85), organ system count (+1.33)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	8.166	19509	n j code lines (+2.87), n distinct rev codes (+2.24), organ system count (+1.23)
T8149XA	Infection following a procedure, other surgical site, initial encounter	CC	7.148	2190	n j code lines (+3.81), n distinct rev codes (+2.22), relative claim charge (+0.79)
D649	Anemia, unspecified	No CC/MCC	6.918	10433	transfusion (+3.30), n j code lines (+0.97), organ system count (+0.94)
L7682	Other postprocedural complications of skin and subcutaneous tissue	No CC/MCC	6.607	2073	n j code lines (+3.64), n distinct rev codes (+1.55), relative claim charge (+0.90)
F419	Anxiety disorder, unspecified	No CC/MCC	5.758	8839	n j code lines (+1.94), n distinct rev codes (+1.54), organ system count (+1.16)
F32A	Depression, unspecified	No CC/MCC	5.564	8498	n j code lines (+1.70), n distinct rev codes (+1.38), organ system count (+1.20)
D509	Iron deficiency anemia, unspecified	No CC/MCC	5.176	2640	transfusion (+2.34), n distinct rev codes (+0.93), organ system count (+0.87)
G40909	Epilepsy, unspecified, not intractable, without status epilepticus	No CC/MCC	4.708	2262	transfusion (+1.62), n distinct rev codes (+0.86), n j code lines (+0.81)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	4.604	12555	n j code lines (+1.41), organ system count (+1.07), n distinct rev codes (+0.95)

Key Driver Frequency

feature	count	pct
n distinct rev codes	296	70.500
organ system count	289	68.800
n j code lines	242	57.600
relative claim charge	171	40.700
or	103	24.500
transfusion	71	16.900
n imaging lines	58	13.800
dialysis	25	6.000
icu	5	1.200

PCS Codes

Data Overview

172 total codes in komodo_rii; 3 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 83.9% of variance; PC1+PC2 together explain 100.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	or	n distinct hcps	organ system count	work rvu	n j code lines	relative claim charge	n imaging lines
1	1.000	2783.000	2.277	0.998	0.999	2.146	1.212	0.009	0.942	0.001
2	1.000	2724.000	2.273	0.999	1.000	2.122	1.205	0.006	0.923	0.000
3	1.000	34773.000	0.724	0.224	0.241	2.606	1.309	0.079	0.994	0.000

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_j_code_lines	0.344	1.000
rate_transfusion	0.344	0.866
avg_organ_system_count	0.343	1.000
avg_work_rvu	0.342	1.000
avg_relative_claim_charge	0.328	1.000
avg_length_of_stay	-0.000	nan
rate_icu	0.000	nan
rate_mechanical_ventilation	-0.000	nan
rate_multiple_or_days	-0.000	nan
avg_n_imaging_lines	-0.169	0.500
rate_dialysis	-0.191	0.000
avg_n_distinct_hcps	-0.344	-1.000
avg_n_distinct_rev_codes	-0.344	-0.500
rate_or	-0.344	-1.000

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=1 codes)

code	Description	Score	N claims	Key drivers
0JBR0ZZ	EXCISION OF LEFT FOOT SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-2.273	2783	dialysis (-0.27), n distinct rev codes (-0.24), transfusion (-0.24)

Tier 2 (n=1 codes)

code	Description	Score	N claims	Key drivers
0JBQ0ZZ	EXCISION OF RIGHT FOOT SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-1.816	2724	relative claim charge (-0.33), work rvu (-0.27), organ system count (-0.26)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
0Q5L0ZZ	DESTRUCTION OF RIGHT TARSAL, OPEN APPROACH	4.089	34773	n distinct rev codes (+0.49), transfusion (+0.49), n distinct hcps (+0.49)

Key Driver Frequency

feature	count	pct
n distinct rev codes	2	66.700
transfusion	2	66.700
n distinct hcps	1	33.300
relative claim charge	1	33.300
work rvu	1	33.300
organ system count	1	33.300
dialysis	1	33.300