OP - LA.0.genomic

CM Codes

Data Overview

7261 total codes in komodo_rii; 72 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	48
CC	24

PCA Analysis

PC1 explains 31.3% of variance; PC1+PC2 together explain 51.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n j code lines	work rvu	organ system count	n distinct hcps	n distinct rev codes	relative claim charge	transfusion	or
1	3.000	1782.000	1.851	2.410	1.754	0.422	2.107	0.913	0.031	0.003
2	12.000	15707.000	0.372	1.213	2.002	0.509	1.871	1.070	0.018	0.001
3	24.000	25147.000	0.288	0.981	1.979	0.580	1.937	1.057	0.006	0.000
4	33.000	36136.000	0.045	0.476	1.201	0.720	1.895	1.006	0.000	0.000

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	1	6	12	5	24
No CC/MCC	2	6	12	28	48
All	3	12	24	33	72

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_hcps	0.406	-0.112	-0.271
avg_relative_claim_charge	0.055	-0.034	0.033
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_n_distinct_rev_codes	-0.052	0.106	-0.257
avg_organ_system_count	-0.115	-0.025	0.068
rate_icu	-0.251	-0.038	-0.004
rate_dialysis	-0.268	0.106	0.339
avg_n_imaging_lines	-0.297	0.139	0.321
rate_or	-0.324	0.295	0.150
rate_transfusion	-0.334	0.256	0.322
avg_n_j_code_lines	-0.400	0.054	0.289
avg_work_rvu	-0.465	0.033	0.193

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
F79	Unspecified intellectual disabilities	No CC/MCC	2.070	4	615	n distinct hcps (+0.68), work rvu (+0.59), n j code lines (+0.20)
F809	Developmental disorder of speech and language, unspecified	No CC/MCC	1.946	4	1554	n distinct hcps (+0.60), work rvu (+0.57), n j code lines (+0.19)
F819	Developmental disorder of scholastic skills, unspecified	No CC/MCC	1.936	4	615	work rvu (+0.61), n distinct hcps (+0.54), n j code lines (+0.20)
F82	Specific developmental disorder of motor function	No CC/MCC	1.925	4	808	n distinct hcps (+0.59), work rvu (+0.56), n j code lines (+0.18)
F902	Attention-deficit hyperactivity disorder, combined type	No CC/MCC	1.897	4	506	work rvu (+0.57), n distinct hcps (+0.53), n j code lines (+0.19)

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

None.

Top Codes by Tier

Tier 1 (n=3 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-5.278	665	icu (-1.89), n imaging lines (-1.40), work rvu (-1.13)
C9202	Acute myeloblastic leukemia, in relapse	CC	-6.327	569	transfusion (-1.95), dialysis (-1.70), n imaging lines (-0.93)
O021	Missed abortion	No CC/MCC	-8.477	548	n j code lines (-3.17), work rvu (-2.33), or (-2.26)

Tier 2 (n=12 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D471	Chronic myeloproliferative disease	CC	-0.991	933	transfusion (-0.34), dialysis (-0.26), work rvu (-0.22)
D619	Aplastic anemia, unspecified	CC	-1.040	746	n imaging lines (-0.92), n distinct hcps (-0.16), transfusion (-0.14)
I10	Essential (primary) hypertension	No CC/MCC	-1.117	3006	work rvu (-0.41), organ system count (-0.23), or (-0.21)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	-1.178	742	or (-0.99), n distinct hcps (-0.43), work rvu (-0.19)
D849	Immunodeficiency, unspecified	CC	-1.192	1015	transfusion (-0.44), n distinct hcps (-0.42), relative claim charge (+0.32)
T865	Complications of stem cell transplant	CC	-1.525	770	n distinct hcps (-0.93), dialysis (-0.47), organ system count (-0.19)
C9200	Acute myeloblastic leukemia, not having achieved remission	CC	-1.838	2725	transfusion (-0.60), dialysis (-0.51), n distinct hcps (-0.45)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-1.907	864	work rvu (-0.79), dialysis (-0.62), n distinct hcps (-0.20)
D509	Iron deficiency anemia, unspecified	No CC/MCC	-2.017	677	n imaging lines (-1.18), dialysis (-0.53), or (-0.18)
D696	Thrombocytopenia, unspecified	No CC/MCC	-2.155	1424	transfusion (-1.06), work rvu (-0.59), n distinct hcps (-0.56)

Tier 3 (n=24 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E559	Vitamin D deficiency, unspecified	No CC/MCC	0.489	873	work rvu (+0.14), organ system count (-0.14), or (+0.11)
C541	Malignant neoplasm of endometrium	No CC/MCC	0.378	544	work rvu (-0.31), transfusion (+0.17), n distinct hcps (+0.12)
C9101	Acute lymphoblastic leukemia, in remission	CC	0.330	1206	n imaging lines (+0.11), dialysis (+0.10), n distinct hcps (+0.09)
D751	Secondary polycythemia	No CC/MCC	0.299	1109	n distinct hcps (-0.77), work rvu (+0.37), transfusion (+0.15)
C9210	Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission	CC	0.183	556	dialysis (-0.17), transfusion (+0.11), or (+0.11)
E669	Obesity, unspecified	No CC/MCC	0.159	661	n distinct hcps (-0.15), transfusion (+0.14), or (+0.11)
C7951	Secondary malignant neoplasm of bone	CC	0.124	935	n imaging lines (-0.23), work rvu (+0.13), or (-0.12)
C771	Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes	CC	0.061	586	or (-0.29), n distinct hcps (+0.20), transfusion (+0.17)
C9100	Acute lymphoblastic leukemia not having achieved remission	CC	0.032	1424	n distinct hcps (-0.14), n imaging lines (+0.11), dialysis (+0.10)
E785	Hyperlipidemia, unspecified	No CC/MCC	-0.053	1567	organ system count (-0.23), work rvu (-0.17), transfusion (+0.13)

Tier 4 (n=33 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F79	Unspecified intellectual disabilities	No CC/MCC	2.070	615	n distinct hcps (+0.68), work rvu (+0.59), n j code lines (+0.20)
F809	Developmental disorder of speech and language, unspecified	No CC/MCC	1.946	1554	n distinct hcps (+0.60), work rvu (+0.57), n j code lines (+0.19)
F819	Developmental disorder of scholastic skills, unspecified	No CC/MCC	1.936	615	work rvu (+0.61), n distinct hcps (+0.54), n j code lines (+0.20)
F82	Specific developmental disorder of motor function	No CC/MCC	1.925	808	n distinct hcps (+0.59), work rvu (+0.56), n j code lines (+0.18)
F902	Attention-deficit hyperactivity disorder, combined type	No CC/MCC	1.897	506	work rvu (+0.57), n distinct hcps (+0.53), n j code lines (+0.19)
C719	Malignant neoplasm of brain, unspecified	CC	1.848	853	n distinct hcps (+0.69), work rvu (+0.35), n j code lines (+0.19)
F840	Autistic disorder	CC	1.818	6551	work rvu (+0.59), n distinct hcps (+0.50), n j code lines (+0.18)
F88	Other disorders of psychological development	No CC/MCC	1.670	2603	work rvu (+0.54), n distinct hcps (+0.43), n j code lines (+0.18)
M6289	Other specified disorders of muscle	No CC/MCC	1.667	785	work rvu (+0.53), n distinct hcps (+0.41), n j code lines (+0.18)
G40909	Epilepsy, unspecified, not intractable, without status epilepticus	No CC/MCC	1.654	567	n distinct hcps (+0.54), work rvu (+0.42), transfusion (+0.17)

Key Driver Frequency

feature	count	pct
n distinct hcps	49	68.100
work rvu	46	63.900
transfusion	37	51.400
n j code lines	27	37.500
organ system count	15	20.800
or	15	20.800
dialysis	13	18.100
n imaging lines	11	15.300
icu	2	2.800
relative claim charge	1	1.400