OP - EN.0.tonsil_removal

CM Codes

Data Overview

4151 total codes in komodo_rii; 74 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	70
CC	4

PCA Analysis

PC1 explains 23.8% of variance; PC1+PC2 together explain 41.9%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n j code lines	work rvu	organ system count	n distinct rev codes	relative claim charge	n distinct hcps	or	n imaging lines
1	1.000	2138.000	7.145	4.625	3.215	6.808	1.018	0.783	0.860	0.001
2	24.000	64954.000	6.958	4.926	2.994	6.505	1.033	0.759	0.868	0.002
3	49.000	480690.000	5.884	5.757	2.369	6.170	1.091	0.734	0.832	0.001

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	0	2	2	4
No CC/MCC	1	22	47	70
All	1	24	49	74

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.273	-0.015	-0.229
avg_relative_claim_charge	0.222	-0.026	-0.143
avg_length_of_stay	0.000	nan	nan
rate_dialysis	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_transfusion	-0.146	0.405	0.042
avg_n_imaging_lines	-0.173	0.050	0.034
avg_n_distinct_hcps	-0.203	-0.021	-0.171
avg_organ_system_count	-0.249	-0.336	0.048
avg_n_distinct_rev_codes	-0.341	-0.316	0.109
rate_or	-0.341	-0.157	-0.123
rate_icu	-0.387	0.359	-0.071
rate_mechanical_ventilation	-0.389	0.178	-0.049
avg_n_j_code_lines	-0.433	-0.110	0.064

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
H6506	Acute serous otitis media, recurrent, bilateral	No CC/MCC	4.709	3	963	relative claim charge (+1.69), or (+1.16), n j code lines (+0.81)
H6523	Chronic serous otitis media, bilateral	No CC/MCC	2.120	3	4732	or (+0.80), n j code lines (+0.75), work rvu (+0.34)
Q381	Ankyloglossia	No CC/MCC	1.942	3	1606	or (+0.39), n distinct rev codes (+0.38), work rvu (+0.35)
G478	Other sleep disorders	No CC/MCC	1.913	3	3442	n j code lines (+0.49), n distinct hcps (+0.40), or (+0.40)
J3503	Chronic tonsillitis and adenoiditis	No CC/MCC	1.807	3	22743	or (+0.59), n j code lines (+0.51), organ system count (+0.39)

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

None.

Top Codes by Tier

Tier 1 (n=1 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F32A	Depression, unspecified	No CC/MCC	-8.207	2138	mechanical ventilation (-3.20), icu (-3.15), n distinct rev codes (-0.54)

Tier 2 (n=24 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J4520	Mild intermittent asthma, uncomplicated	No CC/MCC	-0.303	2009	or (-0.30), n j code lines (-0.19), work rvu (-0.15)
F840	Autistic disorder	CC	-0.416	3617	organ system count (-0.25), or (-0.24), n imaging lines (-0.23)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-0.420	15162	icu (-0.38), work rvu (-0.16), or (-0.15)
L309	Dermatitis, unspecified	No CC/MCC	-0.610	1154	or (-0.44), organ system count (-0.38), n distinct rev codes (+0.22)
J302	Other seasonal allergic rhinitis	No CC/MCC	-0.732	1269	or (-0.40), n distinct rev codes (-0.38), n distinct hcps (-0.31)
J988	Other specified respiratory disorders	No CC/MCC	-0.739	3564	or (-0.65), n distinct hcps (-0.33), organ system count (+0.22)
J4530	Mild persistent asthma, uncomplicated	No CC/MCC	-0.964	1134	transfusion (-0.49), or (-0.42), n j code lines (-0.17)
D649	Anemia, unspecified	No CC/MCC	-0.996	653	organ system count (-0.46), n distinct rev codes (-0.29), work rvu (-0.19)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-1.095	7183	n j code lines (-0.44), organ system count (-0.33), n distinct rev codes (-0.30)
K5900	Constipation, unspecified	No CC/MCC	-1.155	505	or (-0.63), organ system count (-0.43), n j code lines (-0.22)

Tier 3 (n=49 codes)

code	Description	CMS severity	Score	N claims	Key drivers
H6506	Acute serous otitis media, recurrent, bilateral	No CC/MCC	4.709	963	relative claim charge (+1.69), or (+1.16), n j code lines (+0.81)
H6523	Chronic serous otitis media, bilateral	No CC/MCC	2.120	4732	or (+0.80), n j code lines (+0.75), work rvu (+0.34)
Q381	Ankyloglossia	No CC/MCC	1.942	1606	or (+0.39), n distinct rev codes (+0.38), work rvu (+0.35)
G478	Other sleep disorders	No CC/MCC	1.913	3442	n j code lines (+0.49), n distinct hcps (+0.40), or (+0.40)
J3503	Chronic tonsillitis and adenoiditis	No CC/MCC	1.807	22743	or (+0.59), n j code lines (+0.51), organ system count (+0.39)
H6533	Chronic mucoid otitis media, bilateral	No CC/MCC	1.682	2618	n j code lines (+0.46), or (+0.42), work rvu (+0.31)
J343	Hypertrophy of nasal turbinates	No CC/MCC	1.634	11433	work rvu (+0.67), or (+0.25), organ system count (+0.23)
J3489	Other specified disorders of nose and nasal sinuses	No CC/MCC	1.630	5430	or (+0.36), work rvu (+0.32), n distinct rev codes (+0.22)
G479	Sleep disorder, unspecified	No CC/MCC	1.464	2831	or (+0.67), n j code lines (+0.40), n distinct rev codes (+0.32)
H6690	Otitis media, unspecified, unspecified ear	No CC/MCC	1.299	1425	n j code lines (+0.48), n distinct rev codes (+0.28), work rvu (+0.21)

Key Driver Frequency

feature	count	pct
n j code lines	50	67.600
n distinct rev codes	41	55.400
organ system count	34	45.900
work rvu	31	41.900
or	31	41.900
n distinct hcps	16	21.600
relative claim charge	5	6.800
n imaging lines	4	5.400
transfusion	4	5.400
icu	4	5.400
mechanical ventilation	2	2.700

PCS Codes

Data Overview

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

PCA Analysis

PC1 explains 92.3% of variance; PC1+PC2 together explain 100.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	n j code lines	n distinct hcps	or	organ system count	work rvu	relative claim charge	icu
1	1.000	623.000	6.142	5.395	0.966	0.994	2.090	5.068	0.943	0.005
2	1.000	517.000	5.956	5.222	0.986	0.998	2.133	5.069	0.934	0.004
3	1.000	7523.000	2.484	6.043	0.318	0.349	1.779	4.823	1.010	0.000

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_imaging_lines	0.314	0.866
rate_transfusion	0.314	0.866
avg_relative_claim_charge	0.311	1.000
avg_n_j_code_lines	0.306	1.000
avg_length_of_stay	0.000	nan
rate_dialysis	0.000	nan
rate_multiple_or_days	0.000	nan
rate_mechanical_ventilation	-0.163	0.000
rate_icu	-0.310	-0.500
avg_organ_system_count	-0.311	-1.000
avg_n_distinct_hcps	-0.313	-1.000
avg_n_distinct_rev_codes	-0.314	-0.500
avg_work_rvu	-0.314	-1.000
rate_or	-0.314	-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
0CTPXZZ	RESECTION OF TONSILS, EXTERNAL APPROACH	-2.339	623	icu (-0.29), n distinct rev codes (-0.24), mechanical ventilation (-0.23)

Tier 2 (n=1 codes)

code	Description	Score	N claims	Key drivers
0CTQXZZ	RESECTION OF ADENOIDS, EXTERNAL APPROACH	-2.166	517	n j code lines (-0.29), organ system count (-0.26), relative claim charge (-0.26)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
0CTP0ZZ	RESECTION OF TONSILS, OPEN APPROACH	4.505	7523	n imaging lines (+0.44), transfusion (+0.44), work rvu (+0.44)

Key Driver Frequency

feature	count	pct
n j code lines	1	33.300
organ system count	1	33.300
relative claim charge	1	33.300
n imaging lines	1	33.300
transfusion	1	33.300
work rvu	1	33.300
icu	1	33.300
n distinct rev codes	1	33.300
mechanical ventilation	1	33.300