OP - GA.0.colonoscopy

CM Codes

Data Overview

11172 total codes in komodo_rii; 202 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	165
CC	33
MCC	4

PCA Analysis

PC1 explains 26.6% of variance; PC1+PC2 together explain 47.4%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	work rvu	organ system count	n j code lines	or	n distinct rev codes	relative claim charge	n distinct hcps	n imaging lines
1	104.000	9658205.000	7.074	3.924	2.195	0.218	5.645	1.014	0.752	0.005
2	61.000	4479936.000	7.756	3.379	2.325	0.228	5.828	1.104	0.753	0.005
3	35.000	1167010.000	9.771	2.905	2.440	0.232	5.939	1.369	0.739	0.007
4	2.000	9377.000	9.412	2.277	3.479	0.763	6.151	1.442	0.945	0.007

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	9	17	7	0	33
MCC	1	2	1	0	4
No CC/MCC	94	42	27	2	165
All	104	61	35	2	202

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.529	-0.023	0.152
avg_work_rvu	0.477	0.069	-0.129
avg_n_j_code_lines	0.466	-0.182	0.277
avg_n_distinct_rev_codes	0.294	-0.205	-0.086
rate_or	0.287	-0.117	0.118
rate_transfusion	0.189	-0.237	0.168
rate_icu	0.121	0.307	0.030
avg_n_distinct_hcps	0.091	-0.272	-0.039
rate_dialysis	0.060	0.301	0.074
avg_n_imaging_lines	0.032	-0.132	0.220
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_organ_system_count	-0.211	-0.155	-0.317

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D131	Benign neoplasm of stomach	No CC/MCC	8.622	4	5270	n j code lines (+3.04), or (+2.59), relative claim charge (+1.25)
D132	Benign neoplasm of duodenum	No CC/MCC	7.916	4	4107	n j code lines (+2.82), or (+2.11), relative claim charge (+1.24)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K5731	Diverticulosis of large intestine without perforation or abscess with bleeding	MCC	-0.535	1	15766	icu (+0.43), n j code lines (-0.35), work rvu (-0.34)

Top Codes by Tier

Tier 1 (n=104 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1140	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	No CC/MCC	-0.523	16335	n distinct rev codes (+0.52), n j code lines (-0.28), relative claim charge (-0.22)
K5731	Diverticulosis of large intestine without perforation or abscess with bleeding	MCC	-0.535	15766	icu (+0.43), n j code lines (-0.35), work rvu (-0.34)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-0.541	517967	n j code lines (-0.17), relative claim charge (-0.09), n distinct rev codes (-0.06)
F329	Major depressive disorder, single episode, unspecified	No CC/MCC	-0.547	6621	relative claim charge (-0.35), organ system count (-0.22), n distinct hcps (+0.11)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	-0.573	10331	n distinct rev codes (+0.52), relative claim charge (-0.30), or (-0.23)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	-0.578	108568	organ system count (-0.27), n j code lines (-0.26), n distinct rev codes (+0.19)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	-0.581	27017	organ system count (-0.33), n distinct rev codes (+0.31), relative claim charge (-0.17)
J439	Emphysema, unspecified	No CC/MCC	-0.581	11682	organ system count (-0.29), n j code lines (-0.11), n distinct hcps (-0.08)
K580	Irritable bowel syndrome with diarrhea	No CC/MCC	-0.615	9018	n j code lines (-0.18), work rvu (-0.14), organ system count (+0.14)
I739	Peripheral vascular disease, unspecified	No CC/MCC	-0.620	11974	n j code lines (-0.37), organ system count (-0.23), or (-0.16)

Tier 2 (n=61 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D509	Iron deficiency anemia, unspecified	No CC/MCC	1.356	98984	relative claim charge (+0.60), work rvu (+0.40), n distinct rev codes (+0.17)
K3184	Gastroparesis	No CC/MCC	1.308	5068	n j code lines (+0.72), relative claim charge (+0.31), n distinct rev codes (+0.24)
D631	Anemia in chronic kidney disease	No CC/MCC	1.206	5539	n distinct rev codes (+0.68), dialysis (+0.42), organ system count (-0.40)
K5080	Crohn's disease of both small and large intestine without complications	CC	1.199	15664	n j code lines (+0.97), work rvu (-0.42), organ system count (+0.36)
D126	Benign neoplasm of colon, unspecified	No CC/MCC	1.169	54426	work rvu (+0.54), n distinct hcps (+0.48), or (+0.21)
D121	Benign neoplasm of appendix	No CC/MCC	1.055	5766	work rvu (+0.58), relative claim charge (+0.27), or (+0.18)
K5520	Angiodysplasia of colon without hemorrhage	No CC/MCC	0.865	22427	work rvu (+0.63), relative claim charge (+0.32), n j code lines (-0.21)
K639	Disease of intestine, unspecified	No CC/MCC	0.795	6677	work rvu (+0.36), organ system count (+0.29), n j code lines (+0.15)
N186	End stage renal disease	MCC	0.742	12216	n distinct rev codes (+0.91), dialysis (+0.49), organ system count (-0.26)
K2930	Chronic superficial gastritis without bleeding	No CC/MCC	0.727	5853	relative claim charge (+1.08), work rvu (+0.74), n j code lines (-0.67)

Tier 3 (n=35 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K200	Eosinophilic esophagitis	No CC/MCC	4.298	7544	n j code lines (+1.63), relative claim charge (+1.24), work rvu (+0.61)
C182	Malignant neoplasm of ascending colon	CC	4.128	4083	work rvu (+1.58), relative claim charge (+1.35), n distinct rev codes (+0.63)
K2080	Other esophagitis without bleeding	No CC/MCC	3.961	7454	relative claim charge (+1.19), n j code lines (+1.10), work rvu (+1.02)
K269	Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation	No CC/MCC	3.422	10339	relative claim charge (+1.27), work rvu (+0.92), n j code lines (+0.63)
K922	Gastrointestinal hemorrhage, unspecified	CC	3.401	7702	transfusion (+1.51), icu (+0.89), n distinct rev codes (+0.36)
K31A11	Gastric intestinal metaplasia without dysplasia, involving the antrum	No CC/MCC	3.393	5076	work rvu (+1.21), relative claim charge (+1.21), n j code lines (+0.48)
K766	Portal hypertension	CC	3.338	10200	work rvu (+0.83), relative claim charge (+0.80), n j code lines (+0.71)
I8510	Secondary esophageal varices without bleeding	CC	3.332	5845	work rvu (+0.86), relative claim charge (+0.81), n j code lines (+0.66)
K2980	Duodenitis without bleeding	No CC/MCC	3.292	40759	relative claim charge (+1.19), work rvu (+0.85), n j code lines (+0.55)
K3189	Other diseases of stomach and duodenum	No CC/MCC	3.116	109213	relative claim charge (+1.11), work rvu (+0.90), n j code lines (+0.77)

Tier 4 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D131	Benign neoplasm of stomach	No CC/MCC	8.622	5270	n j code lines (+3.04), or (+2.59), relative claim charge (+1.25)
D132	Benign neoplasm of duodenum	No CC/MCC	7.916	4107	n j code lines (+2.82), or (+2.11), relative claim charge (+1.24)

Key Driver Frequency

feature	count	pct
relative claim charge	141	69.800
work rvu	130	64.400
n j code lines	105	52.000
n distinct rev codes	90	44.600
organ system count	85	42.100
or	32	15.800
icu	11	5.400
transfusion	5	2.500
dialysis	3	1.500
n distinct hcps	3	1.500
n imaging lines	1	0.500

PCS Codes

Data Overview

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

PCA Analysis

PC1 explains 85.0% of variance; PC1+PC2 together explain 100.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n j code lines	organ system count	relative claim charge	n distinct hcps	or	n imaging lines
1	1.000	63045.000	5.868	2.331	2.234	2.142	0.945	0.293	0.203	0.001
2	1.000	44985.000	7.123	2.586	2.182	2.546	0.963	0.297	0.179	0.000
3	1.000	8722.000	9.115	3.339	2.805	2.539	1.342	0.407	0.281	0.004

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_hcps	0.325	-1.000
avg_n_distinct_rev_codes	0.325	-1.000
avg_relative_claim_charge	0.325	-1.000
rate_icu	0.324	-0.866
rate_transfusion	0.321	-0.500
avg_n_j_code_lines	0.319	-0.500
avg_n_imaging_lines	0.317	-0.500
avg_work_rvu	0.316	-1.000
rate_or	0.305	-0.500
avg_organ_system_count	0.197	-0.500
avg_length_of_stay	0.000	nan
rate_mechanical_ventilation	0.000	nan
rate_multiple_or_days	0.000	nan
rate_dialysis	-0.201	0.866

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
0DBE8ZX	EXCISION OF LARGE INTESTINE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-2.664	63045	work rvu (-0.36), n distinct rev codes (-0.32), dialysis (-0.28)

Tier 2 (n=1 codes)

code	Description	Score	N claims	Key drivers
0DBE8ZZ	EXCISION OF LARGE INTESTINE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-1.619	44985	or (-0.30), n imaging lines (-0.27), n j code lines (-0.25)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
0DB38ZX	EXCISION OF LOWER ESOPHAGUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	4.283	8722	relative claim charge (+0.46), n distinct hcps (+0.46), icu (+0.46)

Key Driver Frequency

feature	count	pct
work rvu	1	33.300
n distinct rev codes	1	33.300
dialysis	1	33.300
relative claim charge	1	33.300
n distinct hcps	1	33.300
icu	1	33.300
or	1	33.300
n imaging lines	1	33.300
n j code lines	1	33.300