OP - MS.0.knee_replacement

CM Codes

Data Overview

5191 total codes in komodo_rii; 108 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	105
CC	3

PCA Analysis

PC1 explains 22.3% of variance; PC1+PC2 together explain 39.2%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	organ system count	work rvu	n j code lines	n distinct hcps	or	relative claim charge	transfusion
1	3.000	2657.000	9.340	3.773	22.791	10.842	0.926	0.968	0.986	0.000
2	7.000	6942.000	10.137	3.644	23.695	11.261	0.624	0.895	1.027	0.001
3	33.000	383044.000	10.699	3.955	23.899	11.457	0.562	0.911	1.003	0.002
4	43.000	198545.000	10.969	4.418	23.736	11.322	0.518	0.926	1.002	0.003
5	22.000	41560.000	11.170	4.802	23.781	11.763	0.455	0.936	1.011	0.003

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	0	0	0	0	3	3
No CC/MCC	3	7	33	43	19	105
All	3	7	33	43	22	108

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.567	-0.021	0.227
avg_organ_system_count	0.348	-0.223	0.129
avg_n_imaging_lines	0.304	0.132	0.188
rate_transfusion	0.239	-0.001	-0.140
avg_n_j_code_lines	0.211	-0.037	0.234
rate_dialysis	0.175	0.347	0.156
rate_or	0.161	-0.230	0.135
avg_work_rvu	0.134	0.066	-0.008
avg_relative_claim_charge	0.005	0.141	0.120
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_icu	-0.119	0.202	-0.048
avg_n_distinct_hcps	-0.524	-0.051	-0.281

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	2.997	5	3862	dialysis (+0.84), n distinct rev codes (+0.79), n distinct hcps (+0.48)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	2.154	5	510	n distinct rev codes (+0.63), n distinct hcps (+0.47), transfusion (+0.43)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	2.046	5	753	n imaging lines (+0.52), organ system count (+0.47), n distinct hcps (+0.43)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	2.007	5	656	n distinct rev codes (+0.73), n distinct hcps (+0.53), n imaging lines (+0.31)
G894	Chronic pain syndrome	No CC/MCC	1.993	5	688	n distinct rev codes (+1.08), n j code lines (+0.46), organ system count (+0.30)

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
M2241	Chondromalacia patellae, right knee	No CC/MCC	-5.201	1062	n distinct hcps (-2.16), n distinct rev codes (-1.84), organ system count (-0.41)
M2242	Chondromalacia patellae, left knee	No CC/MCC	-5.212	1068	n distinct hcps (-2.06), n distinct rev codes (-2.04), n j code lines (-0.42)
S83242A	Other tear of medial meniscus, current injury, left knee, initial encounter	No CC/MCC	-5.628	527	n distinct rev codes (-2.41), n distinct hcps (-2.26), work rvu (-0.37)

Tier 2 (n=7 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J309	Allergic rhinitis, unspecified	No CC/MCC	-2.253	553	n j code lines (-0.84), n distinct rev codes (-0.76), n distinct hcps (-0.55)
M94261	Chondromalacia, right knee	No CC/MCC	-2.277	563	organ system count (-0.70), n distinct hcps (-0.55), n distinct rev codes (-0.51)
M1732	Unilateral post-traumatic osteoarthritis, left knee	No CC/MCC	-2.726	1239	n distinct rev codes (-0.87), organ system count (-0.61), n distinct hcps (-0.55)
E66812	Obesity, class 2	No CC/MCC	-2.777	652	n distinct rev codes (-1.65), or (-0.66), n j code lines (+0.56)
M1731	Unilateral post-traumatic osteoarthritis, right knee	No CC/MCC	-2.805	1204	n distinct rev codes (-0.92), n distinct hcps (-0.73), organ system count (-0.63)
M794	Hypertrophy of (infrapatellar) fat pad	No CC/MCC	-2.883	1910	n distinct rev codes (-0.90), organ system count (-0.73), n j code lines (-0.44)
E66811	Obesity, class 1	No CC/MCC	-3.250	821	n distinct rev codes (-1.21), icu (-0.76), n j code lines (+0.57)

Tier 3 (n=33 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I739	Peripheral vascular disease, unspecified	No CC/MCC	-0.240	1103	icu (-0.53), n imaging lines (-0.32), n distinct rev codes (+0.28)
E039	Hypothyroidism, unspecified	No CC/MCC	-0.245	16023	organ system count (-0.09), transfusion (-0.09), n imaging lines (-0.06)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-0.279	4828	n imaging lines (-0.14), or (-0.09), n distinct rev codes (-0.08)
I4510	Unspecified right bundle-branch block	No CC/MCC	-0.310	766	n distinct hcps (-0.49), n imaging lines (+0.22), n j code lines (-0.11)
M1712	Unilateral primary osteoarthritis, left knee	No CC/MCC	-0.375	73467	organ system count (-0.58), n distinct hcps (+0.34), n imaging lines (+0.09)
I340	Nonrheumatic mitral (valve) insufficiency	No CC/MCC	-0.414	571	transfusion (+0.57), n distinct hcps (-0.41), n imaging lines (-0.32)
M8580	Other specified disorders of bone density and structure, unspecified site	No CC/MCC	-0.418	1224	n distinct hcps (-0.37), n j code lines (-0.24), organ system count (-0.20)
J4520	Mild intermittent asthma, uncomplicated	No CC/MCC	-0.446	1285	n distinct rev codes (-0.63), n imaging lines (+0.34), organ system count (+0.32)
M21062	Valgus deformity, not elsewhere classified, left knee	No CC/MCC	-0.457	1147	organ system count (-0.54), n imaging lines (+0.23), transfusion (-0.19)
M1711	Unilateral primary osteoarthritis, right knee	No CC/MCC	-0.461	77954	organ system count (-0.57), n distinct hcps (+0.34), n j code lines (-0.10)

Tier 4 (n=43 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N401	Benign prostatic hyperplasia with lower urinary tract symptoms	No CC/MCC	1.092	864	n distinct rev codes (+0.74), organ system count (+0.36), n distinct hcps (-0.33)
I110	Hypertensive heart disease with heart failure	No CC/MCC	1.076	2950	n distinct hcps (+0.48), n imaging lines (+0.39), n j code lines (+0.21)
F411	Generalized anxiety disorder	No CC/MCC	1.066	906	n imaging lines (+0.83), organ system count (+0.41), n distinct hcps (+0.30)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	1.060	949	n imaging lines (+0.55), organ system count (+0.33), transfusion (+0.22)
G629	Polyneuropathy, unspecified	No CC/MCC	1.046	1795	n distinct rev codes (+0.54), organ system count (+0.29), transfusion (+0.19)
E1142	Type 2 diabetes mellitus with diabetic polyneuropathy	No CC/MCC	1.004	1285	n distinct rev codes (+0.66), n distinct hcps (+0.36), n imaging lines (-0.32)
F319	Bipolar disorder, unspecified	No CC/MCC	0.913	751	n imaging lines (+0.51), organ system count (+0.37), transfusion (-0.29)
N182	Chronic kidney disease, stage 2 (mild)	No CC/MCC	0.858	1037	organ system count (+0.40), n imaging lines (-0.32), n distinct hcps (+0.30)
E079	Disorder of thyroid, unspecified	No CC/MCC	0.776	759	transfusion (+0.84), n distinct hcps (+0.44), n distinct rev codes (+0.34)
N1832	Chronic kidney disease, stage 3b	No CC/MCC	0.724	707	organ system count (+0.43), n distinct rev codes (+0.36), n distinct hcps (+0.34)

Tier 5 (n=22 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D62	Acute posthemorrhagic anemia	CC	3.922	1396	n distinct hcps (+1.79), dialysis (+1.12), n distinct rev codes (+0.39)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	2.997	3862	dialysis (+0.84), n distinct rev codes (+0.79), n distinct hcps (+0.48)
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	2.567	1049	n distinct rev codes (+0.86), n distinct hcps (+0.72), n j code lines (+0.41)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	2.154	510	n distinct rev codes (+0.63), n distinct hcps (+0.47), transfusion (+0.43)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	2.046	753	n imaging lines (+0.52), organ system count (+0.47), n distinct hcps (+0.43)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	2.007	656	n distinct rev codes (+0.73), n distinct hcps (+0.53), n imaging lines (+0.31)
G894	Chronic pain syndrome	No CC/MCC	1.993	688	n distinct rev codes (+1.08), n j code lines (+0.46), organ system count (+0.30)
D649	Anemia, unspecified	No CC/MCC	1.990	2752	n imaging lines (+0.90), organ system count (+0.40), n distinct rev codes (+0.36)
E1140	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	No CC/MCC	1.961	1325	n distinct rev codes (+0.71), n imaging lines (+0.48), n distinct hcps (+0.40)
I5032	Chronic diastolic (congestive) heart failure	CC	1.959	862	n distinct hcps (+0.77), n distinct rev codes (+0.52), n imaging lines (+0.41)

Key Driver Frequency

feature	count	pct
n distinct rev codes	71	65.700
n distinct hcps	65	60.200
organ system count	62	57.400
n imaging lines	45	41.700
transfusion	32	29.600
n j code lines	23	21.300
or	12	11.100
work rvu	6	5.600
dialysis	5	4.600
icu	3	2.800