OP - ON.0.SRS

CM Codes

Data Overview

3409 total codes in komodo_rii; 71 retained after n_claims > 500 filter.

CMS severity	n codes
CC	38
No CC/MCC	32
MCC	1

PCA Analysis

PC1 explains 53.1% of variance; PC1+PC2 together explain 69.4%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n j code lines	organ system count	relative claim charge	n imaging lines	or	n distinct hcps
1	52.000	169425.000	1.166	1.344	0.133	1.681	0.975	0.045	0.004	0.592
2	17.000	57247.000	2.890	2.031	0.686	2.355	1.323	0.218	0.024	0.605
3	2.000	2288.000	9.436	3.954	2.602	0.902	1.969	0.578	0.144	0.678

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	34	4	0	38
MCC	0	0	1	1
No CC/MCC	18	13	1	32
All	52	17	2	71

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_j_code_lines	0.427	-0.239	-0.500
avg_n_distinct_rev_codes	0.425	-0.340	-0.554
avg_work_rvu	0.407	-0.236	-0.222
avg_n_imaging_lines	0.405	-0.199	-0.502
avg_relative_claim_charge	0.399	-0.201	-0.395
rate_or	0.369	-0.088	-0.509
avg_n_distinct_hcps	0.071	-0.152	0.098
avg_organ_system_count	0.024	-0.114	-0.373
avg_length_of_stay	-0.000	nan	nan
rate_dialysis	-0.000	nan	nan
rate_mechanical_ventilation	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_icu	-0.021	0.196	0.041
rate_transfusion	-0.077	0.098	0.027

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (1 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G500	Trigeminal neuralgia	No CC/MCC	8.207	3	1561	n imaging lines (+1.91), n j code lines (+1.66), n distinct rev codes (+1.64)

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

None.

Top Codes by Tier

Tier 1 (n=52 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C259	Malignant neoplasm of pancreas, unspecified	CC	0.277	868	work rvu (+0.39), relative claim charge (+0.29), n imaging lines (-0.24)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	0.167	732	n distinct rev codes (+0.17), work rvu (-0.16), n imaging lines (+0.10)
C801	Malignant (primary) neoplasm, unspecified	No CC/MCC	0.131	1399	relative claim charge (+0.24), n imaging lines (+0.12), n distinct rev codes (-0.07)
C251	Malignant neoplasm of body of pancreas	CC	0.119	569	work rvu (+0.52), relative claim charge (+0.40), n imaging lines (-0.33)
C649	Malignant neoplasm of unspecified kidney, except renal pelvis	CC	0.000	1019	transfusion (-0.17), work rvu (+0.10), or (-0.09)
C50912	Malignant neoplasm of unspecified site of left female breast	No CC/MCC	-0.026	687	relative claim charge (+0.17), n imaging lines (-0.11), work rvu (-0.06)
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	-0.053	542	n distinct hcps (-0.23), relative claim charge (+0.20), n distinct rev codes (-0.17)
C250	Malignant neoplasm of head of pancreas	CC	-0.055	1961	work rvu (+0.53), n imaging lines (-0.33), relative claim charge (+0.28)
E039	Hypothyroidism, unspecified	No CC/MCC	-0.084	1665	icu (-0.15), n distinct rev codes (+0.15), work rvu (-0.10)
C50911	Malignant neoplasm of unspecified site of right female breast	No CC/MCC	-0.085	718	or (-0.13), relative claim charge (+0.10), work rvu (-0.08)

Tier 2 (n=17 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D333	Benign neoplasm of cranial nerves	No CC/MCC	4.868	1823	work rvu (+1.00), n imaging lines (+0.90), n j code lines (+0.88)
D329	Benign neoplasm of meninges, unspecified	No CC/MCC	3.208	1803	n j code lines (+0.72), n imaging lines (+0.65), work rvu (+0.64)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	2.780	1081	relative claim charge (+0.59), or (+0.58), n distinct rev codes (+0.55)
D352	Benign neoplasm of pituitary gland	No CC/MCC	2.463	608	work rvu (+0.57), n j code lines (+0.53), n imaging lines (+0.48)
C719	Malignant neoplasm of brain, unspecified	CC	2.120	518	n imaging lines (+0.66), n distinct rev codes (+0.47), n j code lines (+0.35)
D320	Benign neoplasm of cerebral meninges	No CC/MCC	2.112	3055	n imaging lines (+0.46), n distinct rev codes (+0.41), work rvu (+0.40)
C50919	Malignant neoplasm of unspecified site of unspecified female breast	No CC/MCC	1.969	1113	relative claim charge (+0.57), n distinct rev codes (+0.37), work rvu (+0.37)
E785	Hyperlipidemia, unspecified	No CC/MCC	1.802	1940	relative claim charge (+0.60), n distinct rev codes (+0.37), n imaging lines (+0.35)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	1.561	686	or (+0.52), n distinct rev codes (+0.32), n j code lines (+0.29)
I10	Essential (primary) hypertension	No CC/MCC	1.517	4871	relative claim charge (+0.37), n imaging lines (+0.34), n distinct rev codes (+0.32)

Tier 3 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
Q282	Arteriovenous malformation of cerebral vessels	MCC	12.606	727	or (+2.77), n j code lines (+2.38), n distinct rev codes (+2.13)
G500	Trigeminal neuralgia	No CC/MCC	8.207	1561	n imaging lines (+1.91), n j code lines (+1.66), n distinct rev codes (+1.64)

Key Driver Frequency

feature	count	pct
n distinct rev codes	53	74.600
n imaging lines	42	59.200
relative claim charge	41	57.700
work rvu	40	56.300
n j code lines	23	32.400
or	7	9.900
transfusion	3	4.200
n distinct hcps	3	4.200
icu	1	1.400