OP - ON.1.mastectomy

CM Codes

Data Overview

4476 total codes in komodo_rii; 110 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	107
CC	3

PCA Analysis

PC1 explains 32.9% of variance; PC1+PC2 together explain 58.2%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	organ system count	n distinct rev codes	relative claim charge	n distinct hcps	or	n imaging lines
1	29.000	106308.000	17.521	8.516	3.209	8.617	0.919	0.744	0.871	0.001
2	77.000	369318.000	19.633	8.813	4.214	9.404	1.024	0.749	0.920	0.001
3	4.000	12797.000	25.012	10.198	2.866	9.658	1.194	0.882	0.902	0.001

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	0	2	1	3
No CC/MCC	29	75	3	107
All	29	77	4	110

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.499	0.162	0.076
avg_work_rvu	0.488	0.155	-0.024
avg_n_distinct_rev_codes	0.461	0.015	0.252
avg_n_j_code_lines	0.394	0.189	-0.048
rate_or	0.275	-0.177	0.119
avg_n_distinct_hcps	0.157	-0.043	-0.203
avg_n_imaging_lines	0.133	0.189	0.233
rate_dialysis	0.112	0.351	0.294
avg_organ_system_count	0.094	-0.278	0.031
rate_transfusion	0.074	0.108	0.087
avg_length_of_stay	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 (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G8918	Other acute postprocedural pain	No CC/MCC	6.233	3	924	work rvu (+2.25), n j code lines (+1.92), relative claim charge (+1.10)
D360	Benign neoplasm of lymph nodes	No CC/MCC	4.628	3	1052	n j code lines (+2.02), work rvu (+1.48), relative claim charge (+0.98)
C50919	Malignant neoplasm of unspecified site of unspecified female breast	No CC/MCC	4.464	3	1497	work rvu (+1.07), relative claim charge (+1.01), n distinct rev codes (+0.91)

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

None.

Top Codes by Tier

Tier 1 (n=29 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	-1.038	587	n distinct rev codes (-0.55), work rvu (-0.31), relative claim charge (-0.15)
N6011	Diffuse cystic mastopathy of right breast	No CC/MCC	-1.452	4021	n distinct rev codes (-0.55), or (-0.40), relative claim charge (-0.25)
N6092	Unspecified benign mammary dysplasia of left breast	No CC/MCC	-1.612	5970	n distinct rev codes (-0.54), work rvu (-0.37), or (-0.26)
N6012	Diffuse cystic mastopathy of left breast	No CC/MCC	-1.689	3704	n distinct rev codes (-0.49), or (-0.40), relative claim charge (-0.28)
N6091	Unspecified benign mammary dysplasia of right breast	No CC/MCC	-1.689	5657	n distinct rev codes (-0.56), work rvu (-0.35), relative claim charge (-0.34)
N6022	Fibroadenosis of left breast	No CC/MCC	-1.717	3443	n distinct rev codes (-0.54), or (-0.36), relative claim charge (-0.34)
N6082	Other benign mammary dysplasias of left breast	No CC/MCC	-1.727	3413	n distinct rev codes (-0.60), or (-0.35), work rvu (-0.29)
N6021	Fibroadenosis of right breast	No CC/MCC	-1.745	3246	n distinct rev codes (-0.60), or (-0.44), relative claim charge (-0.35)
N6032	Fibrosclerosis of left breast	No CC/MCC	-1.878	2114	n distinct rev codes (-0.53), or (-0.52), relative claim charge (-0.33)
N6001	Solitary cyst of right breast	No CC/MCC	-1.908	762	n distinct rev codes (-0.61), work rvu (-0.43), relative claim charge (-0.36)

Tier 2 (n=77 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5032	Chronic diastolic (congestive) heart failure	CC	2.626	600	dialysis (+1.02), n imaging lines (+0.81), n distinct rev codes (+0.78)
C50211	Malignant neoplasm of upper-inner quadrant of right female breast	No CC/MCC	2.252	5569	relative claim charge (+0.71), work rvu (+0.70), n j code lines (+0.43)
C50812	Malignant neoplasm of overlapping sites of left female breast	No CC/MCC	2.043	7055	relative claim charge (+0.80), work rvu (+0.75), n distinct rev codes (+0.33)
C50811	Malignant neoplasm of overlapping sites of right female breast	No CC/MCC	1.935	7109	relative claim charge (+0.86), work rvu (+0.73), n distinct rev codes (+0.33)
C50412	Malignant neoplasm of upper-outer quadrant of left female breast	No CC/MCC	1.898	16305	work rvu (+0.73), relative claim charge (+0.70), n j code lines (+0.37)
C50511	Malignant neoplasm of lower-outer quadrant of right female breast	No CC/MCC	1.869	3581	work rvu (+0.69), relative claim charge (+0.63), n j code lines (+0.39)
C50411	Malignant neoplasm of upper-outer quadrant of right female breast	No CC/MCC	1.789	16515	relative claim charge (+0.79), work rvu (+0.70), n j code lines (+0.36)
C50212	Malignant neoplasm of upper-inner quadrant of left female breast	No CC/MCC	1.752	5908	work rvu (+0.75), relative claim charge (+0.73), n distinct rev codes (+0.34)
G8929	Other chronic pain	No CC/MCC	1.711	1341	n j code lines (+0.41), or (+0.38), relative claim charge (+0.34)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	1.710	2904	n distinct rev codes (+0.86), dialysis (+0.51), or (+0.46)

Tier 3 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G8918	Other acute postprocedural pain	No CC/MCC	6.233	924	work rvu (+2.25), n j code lines (+1.92), relative claim charge (+1.10)
D360	Benign neoplasm of lymph nodes	No CC/MCC	4.628	1052	n j code lines (+2.02), work rvu (+1.48), relative claim charge (+0.98)
C50919	Malignant neoplasm of unspecified site of unspecified female breast	No CC/MCC	4.464	1497	work rvu (+1.07), relative claim charge (+1.01), n distinct rev codes (+0.91)
C773	Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes	CC	4.225	9324	relative claim charge (+1.98), work rvu (+1.45), n j code lines (+0.70)

Key Driver Frequency

feature	count	pct
n distinct rev codes	80	72.700
relative claim charge	63	57.300
n j code lines	58	52.700
or	53	48.200
work rvu	47	42.700
n distinct hcps	15	13.600
n imaging lines	6	5.500
organ system count	5	4.500
dialysis	2	1.800
transfusion	1	0.900