OP - NU.0.SNS_insertion
CM Codes
Data Overview
3744 total codes in komodo_rii; 53 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 48 |
| CC | 5 |
PCA Analysis
PC1 explains 38.7% of variance; PC1+PC2 together explain 54.4%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | organ system count | work rvu | n distinct rev codes | n j code lines | relative claim charge | or | n distinct hcps | n imaging lines |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 5.000 | 3442.000 | 3.426 | 8.008 | 6.757 | 6.410 | 0.869 | 0.800 | 0.656 | 0.001 |
| 2 | 10.000 | 52926.000 | 3.590 | 8.488 | 7.421 | 6.868 | 1.044 | 0.872 | 0.659 | 0.001 |
| 3 | 38.000 | 102571.000 | 4.683 | 9.183 | 7.805 | 7.012 | 1.095 | 0.914 | 0.690 | 0.000 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 2 | 2 | 1 | 5 |
| No CC/MCC | 3 | 8 | 37 | 48 |
| All | 5 | 10 | 38 | 53 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_distinct_rev_codes | 0.465 | 0.023 | -0.152 |
| rate_or | 0.464 | -0.048 | -0.051 |
| avg_organ_system_count | 0.432 | -0.061 | -0.257 |
| avg_relative_claim_charge | 0.374 | 0.273 | -0.160 |
| avg_work_rvu | 0.349 | 0.318 | -0.367 |
| avg_n_j_code_lines | 0.250 | 0.026 | 0.013 |
| avg_n_distinct_hcps | 0.191 | -0.017 | -0.329 |
| 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 |
| rate_transfusion | -0.094 | 0.108 | -0.225 |
| avg_n_imaging_lines | -0.113 | 0.163 | 0.330 |
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 |
|---|---|---|---|---|---|---|
| D649 | Anemia, unspecified | No CC/MCC | 1.822 | 3 | 938 | organ system count (+0.71), n distinct hcps (+0.36), or (+0.31) |
| M1990 | Unspecified osteoarthritis, unspecified site | No CC/MCC | 1.700 | 3 | 2331 | organ system count (+0.64), n distinct rev codes (+0.43), or (+0.41) |
| M797 | Fibromyalgia | No CC/MCC | 1.654 | 3 | 1177 | organ system count (+0.69), n j code lines (+0.27), relative claim charge (+0.26) |
| M810 | Age-related osteoporosis without current pathological fracture | No CC/MCC | 1.572 | 3 | 739 | organ system count (+0.48), n distinct hcps (+0.38), n distinct rev codes (+0.37) |
| E7800 | Pure hypercholesterolemia, unspecified | No CC/MCC | 1.475 | 3 | 2856 | or (+0.45), n distinct rev codes (+0.32), relative claim charge (+0.29) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=5 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| N393 | Stress incontinence (female) (male) | No CC/MCC | -3.289 | 838 | or (-0.97), organ system count (-0.81), n distinct rev codes (-0.65) |
| N3010 | Interstitial cystitis (chronic) without hematuria | No CC/MCC | -3.324 | 752 | or (-1.37), n distinct rev codes (-1.03), organ system count (-0.86) |
| T85840A | Pain due to nervous system prosthetic devices, implants and grafts, initial encounter | CC | -4.019 | 617 | relative claim charge (-2.10), work rvu (-1.31), n distinct rev codes (-0.80) |
| G894 | Chronic pain syndrome | No CC/MCC | -5.117 | 622 | n distinct rev codes (-1.58), or (-1.29), n j code lines (-0.75) |
| N390 | Urinary tract infection, site not specified | CC | -6.708 | 613 | or (-1.72), n distinct rev codes (-1.19), relative claim charge (-1.07) |
Tier 2 (n=10 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| K3184 | Gastroparesis | No CC/MCC | -0.573 | 1219 | work rvu (-1.40), n j code lines (+1.00), n distinct rev codes (+0.58) |
| T85113A | Breakdown (mechanical) of implanted electronic neurostimulator, generator, initial encounter | CC | -0.741 | 700 | organ system count (-0.54), n distinct hcps (-0.24), work rvu (-0.23) |
| G8929 | Other chronic pain | No CC/MCC | -1.010 | 1438 | n distinct rev codes (-0.65), n imaging lines (-0.36), or (-0.31) |
| G35 | None | No CC/MCC | -1.310 | 818 | n distinct rev codes (-0.52), organ system count (-0.35), work rvu (-0.31) |
| N3946 | Mixed incontinence | No CC/MCC | -1.568 | 4210 | organ system count (-0.69), or (-0.46), work rvu (+0.36) |
| N401 | Benign prostatic hyperplasia with lower urinary tract symptoms | No CC/MCC | -1.641 | 1126 | organ system count (-0.61), n j code lines (-0.41), relative claim charge (-0.32) |
| T85193A | Other mechanical complication of implanted electronic neurostimulator, generator, initial encounter | CC | -1.652 | 788 | work rvu (-0.42), relative claim charge (-0.37), n distinct hcps (-0.35) |
| N3281 | Overactive bladder | No CC/MCC | -2.281 | 18469 | organ system count (-0.87), or (-0.54), n distinct rev codes (-0.53) |
| N319 | Neuromuscular dysfunction of bladder, unspecified | No CC/MCC | -2.505 | 1421 | organ system count (-0.69), n distinct rev codes (-0.58), work rvu (-0.55) |
| N3941 | Urge incontinence | No CC/MCC | -2.669 | 22737 | organ system count (-0.90), or (-0.67), n distinct rev codes (-0.64) |
Tier 3 (n=38 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| D649 | Anemia, unspecified | No CC/MCC | 1.822 | 938 | organ system count (+0.71), n distinct hcps (+0.36), or (+0.31) |
| M1990 | Unspecified osteoarthritis, unspecified site | No CC/MCC | 1.700 | 2331 | organ system count (+0.64), n distinct rev codes (+0.43), or (+0.41) |
| M797 | Fibromyalgia | No CC/MCC | 1.654 | 1177 | organ system count (+0.69), n j code lines (+0.27), relative claim charge (+0.26) |
| M810 | Age-related osteoporosis without current pathological fracture | No CC/MCC | 1.572 | 739 | organ system count (+0.48), n distinct hcps (+0.38), n distinct rev codes (+0.37) |
| E7800 | Pure hypercholesterolemia, unspecified | No CC/MCC | 1.475 | 2856 | or (+0.45), n distinct rev codes (+0.32), relative claim charge (+0.29) |
| 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 | 1.474 | 505 | n distinct rev codes (+0.60), or (+0.51), relative claim charge (+0.27) |
| E782 | Mixed hyperlipidemia | No CC/MCC | 1.342 | 994 | relative claim charge (+0.36), work rvu (+0.33), or (+0.26) |
| I129 | Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease | No CC/MCC | 1.305 | 2186 | or (+0.32), relative claim charge (+0.25), n distinct rev codes (+0.23) |
| G4730 | Sleep apnea, unspecified | No CC/MCC | 1.302 | 2537 | organ system count (+0.40), or (+0.21), n distinct hcps (+0.19) |
| E1122 | Type 2 diabetes mellitus with diabetic chronic kidney disease | No CC/MCC | 1.297 | 1444 | n distinct rev codes (+0.57), relative claim charge (+0.29), or (+0.23) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n distinct rev codes | 34 | 64.200 |
| or | 31 | 58.500 |
| organ system count | 28 | 52.800 |
| relative claim charge | 21 | 39.600 |
| work rvu | 19 | 35.800 |
| n j code lines | 13 | 24.500 |
| n distinct hcps | 9 | 17.000 |
| n imaging lines | 4 | 7.500 |
