OP - RA.0.CTA

CM Codes

Data Overview

15253 total codes in komodo_rii; 229 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	183
CC	34
MCC	12

PCA Analysis

PC1 explains 41.6% of variance; PC1+PC2 together explain 57.3%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	organ system count	n j code lines	n imaging lines	n distinct hcps	relative claim charge	n distinct rev codes	icu
1	163.000	1440518.000	3.003	1.755	0.704	1.171	0.628	1.068	2.567	0.000
2	45.000	218067.000	5.229	2.571	1.146	0.753	0.343	1.199	2.517	0.001
3	21.000	73422.000	6.509	3.098	1.676	0.574	0.192	1.373	2.632	0.004

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	27	3	4	34
MCC	8	4	0	12
No CC/MCC	128	38	17	183
All	163	45	21	229

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_j_code_lines	0.415	-0.063	0.036
avg_work_rvu	0.392	-0.084	-0.053
rate_icu	0.362	0.036	0.048
avg_organ_system_count	0.339	-0.044	-0.176
rate_transfusion	0.220	0.144	-0.051
rate_or	0.213	-0.029	0.017
rate_mechanical_ventilation	0.212	0.014	-0.003
avg_relative_claim_charge	0.184	-0.100	0.006
rate_dialysis	0.103	0.165	0.012
avg_n_distinct_rev_codes	0.039	-0.069	0.109
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
avg_n_imaging_lines	-0.279	-0.021	0.063
avg_n_distinct_hcps	-0.406	-0.011	0.060

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
E8342	Hypomagnesemia	No CC/MCC	7.006	3	1696	n j code lines (+1.68), n distinct hcps (+0.95), work rvu (+0.91)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	6.008	3	2709	n j code lines (+1.19), icu (+0.95), n distinct hcps (+0.94)
I160	Hypertensive urgency	No CC/MCC	5.957	3	1587	icu (+1.87), n j code lines (+1.30), n distinct hcps (+0.97)
F32A	Depression, unspecified	No CC/MCC	5.819	3	3545	n j code lines (+1.04), icu (+1.02), work rvu (+0.95)
D509	Iron deficiency anemia, unspecified	No CC/MCC	5.782	3	1544	transfusion (+1.98), icu (+0.94), n j code lines (+0.68)

Under-tiered: Tier 1, MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G08	Intracranial and intraspinal phlebitis and thrombophlebitis	MCC	-1.810	1	1546	work rvu (-0.29), organ system count (-0.28), n j code lines (-0.28)
I7771	Dissection of carotid artery	MCC	-1.753	1	4410	n imaging lines (-0.54), organ system count (-0.40), n distinct hcps (-0.38)
I7774	Dissection of vertebral artery	MCC	-1.649	1	3908	n imaging lines (-0.57), organ system count (-0.38), n distinct hcps (-0.36)
I639	Cerebral infarction, unspecified	MCC	-1.353	1	11242	n imaging lines (-0.63), organ system count (-0.31), relative claim charge (+0.29)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	-1.272	1	20152	work rvu (-0.34), organ system count (-0.23), n j code lines (-0.20)

Top Codes by Tier

Tier 1 (n=163 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C50919	Malignant neoplasm of unspecified site of unspecified female breast	No CC/MCC	0.276	1416	transfusion (+0.37), icu (-0.19), n imaging lines (+0.18)
E559	Vitamin D deficiency, unspecified	No CC/MCC	0.273	2299	organ system count (+0.44), n distinct hcps (-0.25), icu (+0.18)
I10	Essential (primary) hypertension	No CC/MCC	0.198	128924	n distinct hcps (+0.17), relative claim charge (-0.15), n imaging lines (+0.15)
M7989	Other specified soft tissue disorders	No CC/MCC	0.164	5627	n distinct hcps (+0.21), icu (-0.19), n imaging lines (+0.18)
N289	Disorder of kidney and ureter, unspecified	No CC/MCC	0.159	1658	organ system count (+0.34), icu (-0.08), n imaging lines (+0.05)
H532	Diplopia	No CC/MCC	0.137	2267	work rvu (+0.44), n imaging lines (-0.26), relative claim charge (+0.25)
I872	Venous insufficiency (chronic) (peripheral)	No CC/MCC	0.128	2125	or (+1.22), n j code lines (-0.28), work rvu (-0.24)
I255	Ischemic cardiomyopathy	No CC/MCC	0.038	1435	icu (+0.18), work rvu (-0.14), or (+0.12)
M79605	Pain in left leg	No CC/MCC	0.030	4876	icu (-0.19), n imaging lines (+0.15), n distinct hcps (+0.14)
M79662	Pain in left lower leg	No CC/MCC	0.017	1793	n imaging lines (+0.29), n distinct hcps (+0.23), or (-0.22)

Tier 2 (n=45 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	3.439	17950	work rvu (+0.79), n distinct hcps (+0.78), n j code lines (+0.59)
I110	Hypertensive heart disease with heart failure	No CC/MCC	3.271	5466	n distinct hcps (+0.68), icu (+0.51), n j code lines (+0.51)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	3.182	2021	organ system count (+0.88), icu (+0.67), n j code lines (+0.50)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	3.123	8207	n distinct hcps (+0.77), work rvu (+0.67), n j code lines (+0.61)
E039	Hypothyroidism, unspecified	No CC/MCC	3.029	7838	n distinct hcps (+0.55), icu (+0.55), n j code lines (+0.49)
N186	End stage renal disease	MCC	3.008	1888	dialysis (+1.36), or (+0.43), transfusion (+0.39)
M5450	Low back pain, unspecified	No CC/MCC	2.987	3077	work rvu (+0.90), n distinct hcps (+0.71), n j code lines (+0.62)
J189	Pneumonia, unspecified organism	MCC	2.979	10235	n j code lines (+0.82), n distinct hcps (+0.80), n imaging lines (+0.54)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	2.780	1632	or (+0.93), icu (+0.74), organ system count (+0.55)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	2.695	5993	icu (+0.69), n j code lines (+0.46), organ system count (+0.42)

Tier 3 (n=21 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N179	Acute kidney failure, unspecified	CC	10.675	1786	icu (+3.16), mechanical ventilation (+1.66), n j code lines (+1.36)
E8342	Hypomagnesemia	No CC/MCC	7.006	1696	n j code lines (+1.68), n distinct hcps (+0.95), work rvu (+0.91)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	6.008	2709	n j code lines (+1.19), icu (+0.95), n distinct hcps (+0.94)
I160	Hypertensive urgency	No CC/MCC	5.957	1587	icu (+1.87), n j code lines (+1.30), n distinct hcps (+0.97)
F32A	Depression, unspecified	No CC/MCC	5.819	3545	n j code lines (+1.04), icu (+1.02), work rvu (+0.95)
D509	Iron deficiency anemia, unspecified	No CC/MCC	5.782	1544	transfusion (+1.98), icu (+0.94), n j code lines (+0.68)
E871	Hypo-osmolality and hyponatremia	CC	5.615	1903	icu (+1.15), n j code lines (+1.10), work rvu (+0.85)
D649	Anemia, unspecified	No CC/MCC	5.514	5352	transfusion (+2.28), n distinct hcps (+0.61), organ system count (+0.51)
K5900	Constipation, unspecified	No CC/MCC	5.162	1637	mechanical ventilation (+1.02), icu (+0.71), n j code lines (+0.69)
E876	Hypokalemia	No CC/MCC	5.141	5625	n j code lines (+1.17), n distinct hcps (+0.99), work rvu (+0.96)

Key Driver Frequency

feature	count	pct
work rvu	141	61.600
n distinct hcps	139	60.700
organ system count	129	56.300
n j code lines	103	45.000
n imaging lines	58	25.300
icu	41	17.900
relative claim charge	34	14.800
or	28	12.200
mechanical ventilation	7	3.100
transfusion	5	2.200
dialysis	2	0.900