OP - MS.1.arthrocentesis
CM Codes
Data Overview
17268 total codes in komodo_rii; 278 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 278 |
PCA Analysis
PC1 explains 44.8% of variance; PC1+PC2 together explain 60.2%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | organ system count | n j code lines | n distinct rev codes | relative claim charge | work rvu | or | n distinct hcps | n imaging lines |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 168.000 | 431454.000 | 1.501 | 1.370 | 2.841 | 1.007 | 1.522 | 0.255 | 0.737 | 0.004 |
| 2 | 92.000 | 207080.000 | 2.023 | 1.547 | 3.335 | 1.214 | 1.793 | 0.348 | 0.754 | 0.013 |
| 3 | 18.000 | 17290.000 | 4.048 | 2.411 | 3.927 | 1.694 | 1.945 | 0.446 | 0.720 | 0.013 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| No CC/MCC | 168 | 92 | 18 | 278 |
| All | 168 | 92 | 18 | 278 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_relative_claim_charge | 0.456 | -0.066 | nan |
| avg_n_distinct_rev_codes | 0.439 | -0.021 | nan |
| avg_organ_system_count | 0.384 | -0.245 | nan |
| avg_n_j_code_lines | 0.375 | -0.030 | nan |
| rate_or | 0.347 | -0.055 | nan |
| avg_work_rvu | 0.306 | -0.096 | nan |
| avg_n_imaging_lines | 0.283 | 0.042 | nan |
| rate_transfusion | 0.130 | 0.262 | nan |
| avg_n_distinct_hcps | 0.021 | 0.101 | nan |
| avg_length_of_stay | -0.000 | nan | nan |
| rate_dialysis | -0.000 | nan | nan |
| rate_icu | 0.000 | nan | nan |
| rate_mechanical_ventilation | -0.000 | nan | nan |
| rate_multiple_or_days | 0.000 | nan | nan |
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 |
|---|---|---|---|---|---|---|
| G4733 | Obstructive sleep apnea (adult) (pediatric) | No CC/MCC | 6.811 | 3 | 583 | relative claim charge (+1.86), organ system count (+1.27), n j code lines (+1.18) |
| G4733 | Obstructive sleep apnea (adult) (pediatric) | No CC/MCC | 6.811 | 3 | 583 | relative claim charge (+1.86), organ system count (+1.27), n j code lines (+1.18) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 6.532 | 3 | 757 | relative claim charge (+1.79), n j code lines (+1.63), n distinct rev codes (+1.11) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 6.532 | 3 | 757 | relative claim charge (+1.79), n j code lines (+1.63), n distinct rev codes (+1.11) |
| F32A | Depression, unspecified | No CC/MCC | 6.348 | 3 | 502 | relative claim charge (+1.55), n j code lines (+1.33), n distinct rev codes (+1.14) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=168 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| M19079 | Primary osteoarthritis, unspecified ankle and foot | No CC/MCC | -0.049 | 2680 | n imaging lines (+0.34), relative claim charge (-0.32), or (+0.30) |
| M19079 | Primary osteoarthritis, unspecified ankle and foot | No CC/MCC | -0.049 | 2680 | n imaging lines (+0.34), relative claim charge (-0.32), or (+0.30) |
| M25572 | Pain in left ankle and joints of left foot | No CC/MCC | -0.151 | 7424 | relative claim charge (-0.23), work rvu (-0.17), n imaging lines (+0.15) |
| M25572 | Pain in left ankle and joints of left foot | No CC/MCC | -0.151 | 7424 | relative claim charge (-0.23), work rvu (-0.17), n imaging lines (+0.15) |
| M25571 | Pain in right ankle and joints of right foot | No CC/MCC | -0.154 | 7618 | n imaging lines (+0.26), relative claim charge (-0.23), work rvu (-0.17) |
| M25571 | Pain in right ankle and joints of right foot | No CC/MCC | -0.154 | 7618 | n imaging lines (+0.26), relative claim charge (-0.23), work rvu (-0.17) |
| M25521 | Pain in right elbow | No CC/MCC | -0.192 | 2546 | n j code lines (-0.30), n distinct rev codes (+0.24), organ system count (-0.19) |
| M25521 | Pain in right elbow | No CC/MCC | -0.192 | 2546 | n j code lines (-0.30), n distinct rev codes (+0.24), organ system count (-0.19) |
| M1711 | Unilateral primary osteoarthritis, right knee | No CC/MCC | -0.244 | 1575 | relative claim charge (+0.21), n distinct rev codes (-0.21), organ system count (-0.19) |
| M1711 | Unilateral primary osteoarthritis, right knee | No CC/MCC | -0.244 | 1575 | relative claim charge (+0.21), n distinct rev codes (-0.21), organ system count (-0.19) |
Tier 2 (n=92 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| E039 | Hypothyroidism, unspecified | No CC/MCC | 3.189 | 1094 | organ system count (+0.90), n distinct rev codes (+0.86), relative claim charge (+0.70) |
| E039 | Hypothyroidism, unspecified | No CC/MCC | 3.189 | 1094 | organ system count (+0.90), n distinct rev codes (+0.86), relative claim charge (+0.70) |
| I10 | Essential (primary) hypertension | No CC/MCC | 3.009 | 5344 | organ system count (+0.82), n distinct rev codes (+0.70), relative claim charge (+0.65) |
| I10 | Essential (primary) hypertension | No CC/MCC | 3.009 | 5344 | organ system count (+0.82), n distinct rev codes (+0.70), relative claim charge (+0.65) |
| M25472 | Effusion, left ankle | No CC/MCC | 2.809 | 510 | n distinct rev codes (+0.92), n imaging lines (+0.78), work rvu (+0.66) |
| M25472 | Effusion, left ankle | No CC/MCC | 2.809 | 510 | n distinct rev codes (+0.92), n imaging lines (+0.78), work rvu (+0.66) |
| M533 | Sacrococcygeal disorders, not elsewhere classified | No CC/MCC | 2.760 | 2800 | or (+1.17), n j code lines (+0.70), n distinct rev codes (+0.67) |
| M533 | Sacrococcygeal disorders, not elsewhere classified | No CC/MCC | 2.760 | 2800 | or (+1.17), n j code lines (+0.70), n distinct rev codes (+0.67) |
| E6601 | Morbid (severe) obesity due to excess calories | No CC/MCC | 2.657 | 665 | organ system count (+0.76), n j code lines (+0.59), n distinct rev codes (+0.54) |
| E6601 | Morbid (severe) obesity due to excess calories | No CC/MCC | 2.657 | 665 | organ system count (+0.76), n j code lines (+0.59), n distinct rev codes (+0.54) |
Tier 3 (n=18 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| G4733 | Obstructive sleep apnea (adult) (pediatric) | No CC/MCC | 6.811 | 583 | relative claim charge (+1.86), organ system count (+1.27), n j code lines (+1.18) |
| G4733 | Obstructive sleep apnea (adult) (pediatric) | No CC/MCC | 6.811 | 583 | relative claim charge (+1.86), organ system count (+1.27), n j code lines (+1.18) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 6.532 | 757 | relative claim charge (+1.79), n j code lines (+1.63), n distinct rev codes (+1.11) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 6.532 | 757 | relative claim charge (+1.79), n j code lines (+1.63), n distinct rev codes (+1.11) |
| F32A | Depression, unspecified | No CC/MCC | 6.348 | 502 | relative claim charge (+1.55), n j code lines (+1.33), n distinct rev codes (+1.14) |
| F32A | Depression, unspecified | No CC/MCC | 6.348 | 502 | relative claim charge (+1.55), n j code lines (+1.33), n distinct rev codes (+1.14) |
| J45909 | Unspecified asthma, uncomplicated | No CC/MCC | 6.091 | 822 | n j code lines (+1.46), relative claim charge (+1.33), organ system count (+1.04) |
| J45909 | Unspecified asthma, uncomplicated | No CC/MCC | 6.091 | 822 | n j code lines (+1.46), relative claim charge (+1.33), organ system count (+1.04) |
| I2510 | Atherosclerotic heart disease of native coronary artery without angina pectoris | No CC/MCC | 5.574 | 693 | n distinct rev codes (+1.14), relative claim charge (+1.12), organ system count (+1.04) |
| I2510 | Atherosclerotic heart disease of native coronary artery without angina pectoris | No CC/MCC | 5.574 | 693 | n distinct rev codes (+1.14), relative claim charge (+1.12), organ system count (+1.04) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n distinct rev codes | 158 | 56.800 |
| relative claim charge | 152 | 54.700 |
| work rvu | 142 | 51.100 |
| or | 126 | 45.300 |
| organ system count | 104 | 37.400 |
| n j code lines | 78 | 28.100 |
| n imaging lines | 64 | 23.000 |
| transfusion | 10 | 3.600 |
