OP - GA.0.egd

CM Codes

Data Overview

11499 total codes in komodo_rii; 281 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	219
CC	51
MCC	11

PCA Analysis

PC1 explains 27.5% of variance; PC1+PC2 together explain 49.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	n j code lines	work rvu	relative claim charge	organ system count	n distinct hcps	n imaging lines	or
1	222.000	8949136.000	5.827	2.515	5.434	1.050	3.432	0.713	0.007	0.227
2	53.000	445488.000	6.212	2.967	6.162	1.182	3.405	0.689	0.016	0.231
3	6.000	42909.000	7.804	4.152	6.548	1.314	3.546	0.593	0.086	0.280

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	23	26	2	51
MCC	4	7	0	11
No CC/MCC	195	20	4	219
All	222	53	6	281

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_imaging_lines	0.476	-0.269	0.384
avg_n_distinct_rev_codes	0.425	-0.217	0.191
rate_icu	0.416	0.274	0.034
avg_n_j_code_lines	0.365	-0.346	0.274
rate_transfusion	0.363	-0.064	0.223
rate_mechanical_ventilation	0.186	-0.093	-0.032
avg_relative_claim_charge	0.185	-0.118	0.217
rate_dialysis	0.176	0.235	0.103
avg_work_rvu	0.109	0.004	0.146
rate_or	0.069	-0.048	0.064
avg_organ_system_count	0.036	-0.175	-0.134
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
avg_n_distinct_hcps	-0.192	-0.174	-0.187

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
E876	Hypokalemia	No CC/MCC	12.759	3	2564	icu (+3.60), n imaging lines (+3.54), n distinct rev codes (+2.04)
T18198A	Other foreign object in esophagus causing other injury, initial encounter	No CC/MCC	10.282	3	2442	n imaging lines (+3.21), mechanical ventilation (+3.12), n distinct rev codes (+1.46)
T18108A	Unspecified foreign body in esophagus causing other injury, initial encounter	No CC/MCC	8.215	3	3085	n imaging lines (+3.76), n distinct rev codes (+2.17), n j code lines (+2.12)
T18128A	Food in esophagus causing other injury, initial encounter	No CC/MCC	7.562	3	27171	n imaging lines (+2.48), n j code lines (+2.23), n distinct rev codes (+2.18)

Under-tiered: Tier 1, MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
Q394	Esophageal web	MCC	-0.670	1	2624	n imaging lines (-0.18), icu (-0.12), transfusion (-0.10)
K562	Volvulus	MCC	-0.430	1	2738	n distinct rev codes (-0.32), relative claim charge (+0.21), work rvu (+0.15)
K2951	Unspecified chronic gastritis with bleeding	MCC	-0.215	1	7337	n j code lines (-0.31), transfusion (+0.12), icu (-0.12)
K8590	Acute pancreatitis without necrosis or infection, unspecified	MCC	0.134	1	7790	n j code lines (+0.43), n distinct rev codes (-0.21), icu (-0.12)

Top Codes by Tier

Tier 1 (n=222 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D123	Benign neoplasm of transverse colon	No CC/MCC	0.292	24084	n distinct rev codes (-0.77), relative claim charge (+0.72), n distinct hcps (+0.65)
D132	Benign neoplasm of duodenum	No CC/MCC	0.290	16926	n j code lines (+0.62), n distinct hcps (-0.56), or (+0.37)
D120	Benign neoplasm of cecum	No CC/MCC	0.286	12513	n distinct rev codes (-0.78), relative claim charge (+0.70), n distinct hcps (+0.64)
K311	Adult hypertrophic pyloric stenosis	CC	0.272	10550	n j code lines (+0.32), relative claim charge (+0.15), icu (-0.12)
D130	Benign neoplasm of esophagus	No CC/MCC	0.268	13356	n j code lines (+0.74), n distinct hcps (-0.72), or (+0.53)
I5030	Unspecified diastolic (congestive) heart failure	CC	0.235	2595	n distinct rev codes (+0.30), icu (-0.12), dialysis (+0.10)
D128	Benign neoplasm of rectum	No CC/MCC	0.222	6382	n distinct rev codes (-0.70), relative claim charge (+0.64), n distinct hcps (+0.46)
N1831	Chronic kidney disease, stage 3a	No CC/MCC	0.218	8882	n distinct rev codes (+0.19), icu (+0.10), or (-0.09)
F909	Attention-deficit hyperactivity disorder, unspecified type	No CC/MCC	0.215	10484	n j code lines (+0.50), or (+0.15), n imaging lines (-0.15)
D125	Benign neoplasm of sigmoid colon	No CC/MCC	0.200	14344	n distinct rev codes (-0.86), relative claim charge (+0.70), n distinct hcps (+0.67)

Tier 2 (n=53 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K922	Gastrointestinal hemorrhage, unspecified	CC	4.940	7993	transfusion (+1.52), icu (+1.24), n imaging lines (+0.99)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.334	2336	dialysis (+2.13), n distinct rev codes (+0.97), transfusion (+0.19)
C787	Secondary malignant neoplasm of liver and intrahepatic bile duct	CC	2.837	2780	n imaging lines (+0.58), n distinct rev codes (+0.56), n j code lines (+0.54)
K254	Chronic or unspecified gastric ulcer with hemorrhage	MCC	2.780	5469	transfusion (+1.02), icu (+0.90), n imaging lines (+0.57)
C259	Malignant neoplasm of pancreas, unspecified	CC	2.624	2844	n j code lines (+0.86), n distinct rev codes (+0.53), n imaging lines (+0.52)
K920	Hematemesis	CC	2.453	10205	n imaging lines (+1.09), icu (+0.77), transfusion (+0.23)
K56699	Other intestinal obstruction unspecified as to partial versus complete obstruction	CC	2.271	3339	n imaging lines (+1.07), n j code lines (+0.62), n distinct rev codes (+0.45)
C251	Malignant neoplasm of body of pancreas	CC	2.269	3041	n distinct rev codes (+1.23), n j code lines (+0.63), relative claim charge (+0.42)
C250	Malignant neoplasm of head of pancreas	CC	2.235	3869	n distinct rev codes (+1.12), n j code lines (+0.83), relative claim charge (+0.46)
K831	Obstruction of bile duct	MCC	2.167	3086	n j code lines (+1.30), relative claim charge (+0.41), n distinct hcps (+0.33)

Tier 3 (n=6 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D62	Acute posthemorrhagic anemia	CC	14.364	4538	transfusion (+5.07), icu (+3.96), n distinct rev codes (+1.93)
E876	Hypokalemia	No CC/MCC	12.759	2564	icu (+3.60), n imaging lines (+3.54), n distinct rev codes (+2.04)
T18198A	Other foreign object in esophagus causing other injury, initial encounter	No CC/MCC	10.282	2442	n imaging lines (+3.21), mechanical ventilation (+3.12), n distinct rev codes (+1.46)
N179	Acute kidney failure, unspecified	CC	9.128	3109	icu (+2.97), n distinct rev codes (+1.63), n imaging lines (+1.61)
T18108A	Unspecified foreign body in esophagus causing other injury, initial encounter	No CC/MCC	8.215	3085	n imaging lines (+3.76), n distinct rev codes (+2.17), n j code lines (+2.12)
T18128A	Food in esophagus causing other injury, initial encounter	No CC/MCC	7.562	27171	n imaging lines (+2.48), n j code lines (+2.23), n distinct rev codes (+2.18)

Key Driver Frequency

feature	count	pct
n distinct rev codes	182	64.800
n j code lines	167	59.400
n imaging lines	160	56.900
icu	119	42.300
relative claim charge	84	29.900
n distinct hcps	66	23.500
transfusion	45	16.000
or	9	3.200
dialysis	6	2.100
work rvu	4	1.400
mechanical ventilation	1	0.400