OP - ON.0.chemotherapy

CM Codes

Data Overview

12142 total codes in komodo_rii; 306 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	166
CC	136
MCC	4

PCA Analysis

PC1 explains 31.3% of variance; PC1+PC2 together explain 48.4%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n j code lines	n distinct rev codes	organ system count	work rvu	n distinct hcps	relative claim charge	or	transfusion
1	11.000	36244.000	1.487	2.110	1.204	0.494	0.264	1.069	0.001	0.000
2	64.000	1024188.000	3.740	3.640	1.617	0.675	0.496	0.901	0.004	0.002
3	93.000	681976.000	5.192	4.392	2.081	0.855	0.584	0.995	0.006	0.003
4	109.000	1329152.000	6.031	5.085	2.906	1.019	0.609	1.141	0.009	0.003
5	29.000	324499.000	6.201	5.531	2.909	1.256	0.673	1.189	0.016	0.007

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	6	35	41	41	13	136
MCC	0	0	0	1	3	4
No CC/MCC	5	29	52	67	13	166
All	11	64	93	109	29	306

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.482	-0.032	-0.114
avg_work_rvu	0.447	-0.009	0.076
avg_n_j_code_lines	0.369	0.049	0.008
rate_or	0.352	0.066	-0.042
avg_n_distinct_hcps	0.349	-0.028	0.014
avg_organ_system_count	0.292	-0.112	-0.305
avg_relative_claim_charge	0.213	-0.039	0.118
rate_transfusion	0.149	0.024	-0.085
rate_icu	0.139	0.236	0.051
avg_n_imaging_lines	0.086	-0.015	-0.093
rate_dialysis	0.059	0.224	-0.079
rate_mechanical_ventilation	0.048	0.132	0.088
avg_length_of_stay	-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 5, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D84821	Immunodeficiency due to drugs	No CC/MCC	4.894	5	16355	work rvu (+1.71), or (+1.22), n distinct rev codes (+0.81)
K5903	Drug induced constipation	No CC/MCC	3.739	5	6023	or (+1.09), work rvu (+0.85), n distinct rev codes (+0.71)
K8689	Other specified diseases of pancreas	No CC/MCC	3.382	5	4368	n j code lines (+0.84), n distinct rev codes (+0.83), work rvu (+0.67)
E806	Other disorders of bilirubin metabolism	No CC/MCC	3.201	5	2159	n distinct rev codes (+0.89), work rvu (+0.71), n distinct hcps (+0.54)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	2.858	5	3493	or (+0.75), organ system count (+0.74), n distinct rev codes (+0.61)

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

None.

Top Codes by Tier

Tier 1 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C4359	Malignant melanoma of other part of trunk	No CC/MCC	-3.763	2881	n distinct rev codes (-1.22), n j code lines (-0.80), n distinct hcps (-0.73)
L732	Hidradenitis suppurativa	No CC/MCC	-4.487	2325	n distinct rev codes (-1.46), n distinct hcps (-1.14), n j code lines (-0.92)
K5090	Crohn's disease, unspecified, without complications	CC	-4.621	6249	n distinct rev codes (-1.42), n distinct hcps (-1.07), n j code lines (-0.93)
K5190	Ulcerative colitis, unspecified, without complications	CC	-4.857	3924	n distinct rev codes (-1.31), n distinct hcps (-0.94), n j code lines (-0.88)
O019	Hydatidiform mole, unspecified	No CC/MCC	-4.868	1898	work rvu (-1.10), n distinct rev codes (-1.01), relative claim charge (-0.84)
K5080	Crohn's disease of both small and large intestine without complications	CC	-4.888	4230	n distinct rev codes (-1.56), n distinct hcps (-1.32), n j code lines (-1.00)
L4050	Arthropathic psoriasis, unspecified	No CC/MCC	-5.042	2482	n distinct rev codes (-1.35), n distinct hcps (-1.05), n j code lines (-0.84)
M0579	Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement	No CC/MCC	-5.101	4248	n distinct rev codes (-1.28), n distinct hcps (-1.00), work rvu (-0.82)
K5000	Crohn's disease of small intestine without complications	CC	-5.543	2756	n distinct rev codes (-1.57), n distinct hcps (-1.23), n j code lines (-0.98)
K5010	Crohn's disease of large intestine without complications	CC	-5.763	1937	n distinct rev codes (-1.54), n distinct hcps (-1.25), n j code lines (-0.99)

Tier 2 (n=64 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C792	Secondary malignant neoplasm of skin	CC	-1.400	3404	n distinct rev codes (-0.31), or (-0.28), work rvu (-0.26)
C9002	Multiple myeloma in relapse	CC	-1.408	7332	n j code lines (-0.64), n distinct rev codes (-0.55), relative claim charge (+0.42)
C3411	Malignant neoplasm of upper lobe, right bronchus or lung	CC	-1.554	28745	work rvu (-0.46), n distinct rev codes (-0.29), relative claim charge (-0.20)
C3491	Malignant neoplasm of unspecified part of right bronchus or lung	CC	-1.566	23255	work rvu (-0.43), relative claim charge (-0.27), n distinct rev codes (-0.23)
C342	Malignant neoplasm of middle lobe, bronchus or lung	CC	-1.585	4642	work rvu (-0.48), n distinct rev codes (-0.34), organ system count (-0.19)
C7951	Secondary malignant neoplasm of bone	CC	-1.586	88549	n distinct rev codes (-0.35), work rvu (-0.29), or (-0.23)
C50919	Malignant neoplasm of unspecified site of unspecified female breast	No CC/MCC	-1.610	47317	work rvu (-0.33), organ system count (-0.30), n j code lines (-0.24)
C9241	Acute promyelocytic leukemia, in remission	CC	-1.621	7785	work rvu (-0.65), n j code lines (-0.59), n distinct hcps (+0.36)
C7A1	Malignant poorly differentiated neuroendocrine tumors	CC	-1.669	7417	work rvu (-0.46), relative claim charge (-0.30), n distinct rev codes (-0.28)
C3431	Malignant neoplasm of lower lobe, right bronchus or lung	CC	-1.688	14238	work rvu (-0.42), n distinct rev codes (-0.32), relative claim charge (-0.21)

Tier 3 (n=93 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D701	Agranulocytosis secondary to cancer chemotherapy	No CC/MCC	0.462	39618	n j code lines (+0.34), work rvu (+0.19), n distinct hcps (-0.09)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	0.456	4279	organ system count (+0.47), n distinct rev codes (+0.37), work rvu (-0.24)
D702	Other drug-induced agranulocytosis	No CC/MCC	0.443	2037	or (+0.19), n distinct rev codes (+0.18), n j code lines (+0.15)
C799	Secondary malignant neoplasm of unspecified site	CC	0.426	9854	work rvu (+0.22), organ system count (-0.21), n j code lines (+0.17)
E039	Hypothyroidism, unspecified	No CC/MCC	0.407	23615	organ system count (+0.32), n distinct rev codes (+0.25), n j code lines (-0.15)
T451X5S	Adverse effect of antineoplastic and immunosuppressive drugs, sequela	No CC/MCC	0.386	2253	organ system count (+0.37), n j code lines (+0.18), or (-0.18)
C8330	Diffuse large B-cell lymphoma, unspecified site	CC	0.377	5319	n distinct rev codes (-0.52), work rvu (+0.51), n distinct hcps (-0.43)
C689	Malignant neoplasm of urinary organ, unspecified	CC	0.367	4219	or (+0.51), n distinct hcps (+0.27), work rvu (-0.27)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	0.349	2305	transfusion (+0.38), work rvu (-0.27), n distinct rev codes (+0.12)
C7800	Secondary malignant neoplasm of unspecified lung	CC	0.320	21287	or (+0.17), n j code lines (+0.15), work rvu (+0.14)

Tier 4 (n=109 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C170	Malignant neoplasm of duodenum	CC	2.142	3343	or (+0.61), n j code lines (+0.58), n distinct rev codes (+0.51)
C251	Malignant neoplasm of body of pancreas	CC	2.116	12300	n j code lines (+0.80), work rvu (+0.56), n distinct rev codes (+0.52)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	2.112	6333	n distinct rev codes (+0.45), work rvu (+0.40), organ system count (+0.32)
F419	Anxiety disorder, unspecified	No CC/MCC	2.110	20918	organ system count (+0.53), n distinct rev codes (+0.48), work rvu (+0.34)
G620	Drug-induced polyneuropathy	No CC/MCC	2.109	23757	work rvu (+0.58), n distinct rev codes (+0.53), organ system count (+0.47)
C257	Malignant neoplasm of other parts of pancreas	CC	2.075	3035	n j code lines (+0.74), n distinct rev codes (+0.58), work rvu (+0.48)
N1330	Unspecified hydronephrosis	CC	2.061	2676	n distinct rev codes (+0.47), organ system count (+0.42), icu (+0.38)
C162	Malignant neoplasm of body of stomach	CC	2.021	2805	work rvu (+0.53), n j code lines (+0.52), relative claim charge (+0.39)
K769	Liver disease, unspecified	No CC/MCC	1.986	3164	work rvu (+0.55), n j code lines (+0.40), n distinct rev codes (+0.32)
G4700	Insomnia, unspecified	No CC/MCC	1.976	8445	n distinct rev codes (+0.58), organ system count (+0.53), work rvu (+0.37)

Tier 5 (n=29 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E43	Unspecified severe protein-calorie malnutrition	MCC	5.230	1960	icu (+1.20), n distinct rev codes (+0.86), work rvu (+0.85)
C9101	Acute lymphoblastic leukemia, in remission	CC	5.119	26667	or (+2.35), work rvu (+1.56), n distinct rev codes (+0.88)
D84821	Immunodeficiency due to drugs	No CC/MCC	4.894	16355	work rvu (+1.71), or (+1.22), n distinct rev codes (+0.81)
C9102	Acute lymphoblastic leukemia, in relapse	CC	4.307	2334	work rvu (+1.45), transfusion (+1.06), or (+0.91)
D61810	Antineoplastic chemotherapy induced pancytopenia	MCC	3.884	8349	or (+0.97), work rvu (+0.80), transfusion (+0.74)
C9100	Acute lymphoblastic leukemia not having achieved remission	CC	3.829	45010	or (+1.65), work rvu (+1.29), n distinct rev codes (+0.54)
K5903	Drug induced constipation	No CC/MCC	3.739	6023	or (+1.09), work rvu (+0.85), n distinct rev codes (+0.71)
D849	Immunodeficiency, unspecified	CC	3.401	9937	or (+1.08), icu (+0.79), work rvu (+0.71)
K8689	Other specified diseases of pancreas	No CC/MCC	3.382	4368	n j code lines (+0.84), n distinct rev codes (+0.83), work rvu (+0.67)
C8350	Lymphoblastic (diffuse) lymphoma, unspecified site	CC	3.317	3751	or (+1.64), work rvu (+1.11), transfusion (+0.81)

Key Driver Frequency

feature	count	pct
n distinct rev codes	212	69.300
work rvu	177	57.800
n j code lines	134	43.800
organ system count	120	39.200
n distinct hcps	110	35.900
or	82	26.800
relative claim charge	50	16.300
transfusion	13	4.200
icu	8	2.600
n imaging lines	8	2.600
mechanical ventilation	3	1.000
dialysis	1	0.300