OP - RA.0.EPS

CM Codes

Data Overview

4716 total codes in komodo_rii; 132 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	109
CC	22
MCC	1

PCA Analysis

PC1 explains 26.1% of variance; PC1+PC2 together explain 41.2%.

Tier Clustering (k=5)

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	5.000	52284.000	19.494	7.821	2.246	8.489	0.884	0.710	0.046	0.007
2	22.000	57893.000	21.718	8.524	3.487	9.087	0.970	0.715	0.069	0.010
3	50.000	449323.000	22.556	8.874	3.288	9.202	1.019	0.702	0.068	0.014
4	48.000	251800.000	23.211	8.927	2.964	9.516	1.047	0.674	0.074	0.016
5	7.000	82855.000	24.690	9.758	2.663	9.667	1.114	0.653	0.071	0.019

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	1	0	5	12	4	22
MCC	0	0	1	0	0	1
No CC/MCC	4	22	44	36	3	109
All	5	22	50	48	7	132

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.525	0.204	0.416
avg_relative_claim_charge	0.481	0.122	0.262
avg_n_distinct_rev_codes	0.412	-0.091	0.156
avg_n_j_code_lines	0.357	0.056	0.183
avg_n_imaging_lines	0.295	-0.015	0.003
rate_transfusion	0.177	0.090	-0.102
rate_or	0.140	0.057	-0.104
rate_dialysis	0.026	0.336	0.238
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_organ_system_count	-0.062	-0.315	-0.253
rate_icu	-0.070	0.339	0.030
avg_n_distinct_hcps	-0.221	-0.140	-0.221

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I700	Atherosclerosis of aorta	No CC/MCC	4.412	5	2231	n imaging lines (+1.36), work rvu (+1.07), n distinct rev codes (+1.00)
I083	Combined rheumatic disorders of mitral, aortic and tricuspid valves	No CC/MCC	2.704	5	1937	work rvu (+0.73), n distinct rev codes (+0.57), transfusion (+0.32)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	2.606	5	1988	relative claim charge (+0.65), work rvu (+0.62), n j code lines (+0.37)

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
F909	Attention-deficit hyperactivity disorder, unspecified type	No CC/MCC	-3.997	572	work rvu (-1.53), n distinct rev codes (-0.97), relative claim charge (-0.91)
I4719	Other supraventricular tachycardia	No CC/MCC	-4.316	16236	work rvu (-1.22), n distinct rev codes (-1.09), relative claim charge (-1.01)
I456	Pre-excitation syndrome	No CC/MCC	-4.915	4042	work rvu (-1.69), n distinct rev codes (-1.05), relative claim charge (-0.97)
I4710	Supraventricular tachycardia, unspecified	No CC/MCC	-5.411	17214	work rvu (-1.68), relative claim charge (-1.27), n distinct rev codes (-1.06)
I471	None	CC	-6.556	14220	relative claim charge (-1.86), work rvu (-1.58), n j code lines (-1.43)

Tier 2 (n=22 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G40909	Epilepsy, unspecified, not intractable, without status epilepticus	No CC/MCC	-1.192	514	n imaging lines (-0.50), n distinct rev codes (-0.40), work rvu (-0.21)
E890	Postprocedural hypothyroidism	No CC/MCC	-1.263	746	n imaging lines (-0.43), n distinct rev codes (-0.34), relative claim charge (-0.34)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	-1.264	4528	relative claim charge (-0.29), work rvu (-0.24), n distinct rev codes (-0.21)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-1.276	7597	n distinct rev codes (-0.43), work rvu (-0.38), n distinct hcps (-0.28)
E663	Overweight	No CC/MCC	-1.451	893	n imaging lines (-0.58), n j code lines (-0.32), n distinct rev codes (-0.26)
I341	Nonrheumatic mitral (valve) prolapse	No CC/MCC	-1.538	1278	n distinct rev codes (-0.57), relative claim charge (-0.36), work rvu (-0.27)
F32A	Depression, unspecified	No CC/MCC	-1.640	3777	relative claim charge (-0.54), work rvu (-0.51), n distinct rev codes (-0.25)
I4729	Other ventricular tachycardia	No CC/MCC	-1.647	1335	relative claim charge (-0.70), n j code lines (-0.32), n distinct rev codes (-0.31)
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	-1.650	1203	work rvu (-0.52), relative claim charge (-0.36), n j code lines (-0.34)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-1.670	6564	work rvu (-0.58), n distinct rev codes (-0.54), relative claim charge (-0.35)

Tier 3 (n=50 codes)

code	Description	CMS severity	Score	N claims	Key drivers
Q2112	Patent foramen ovale	No CC/MCC	0.421	1355	n distinct rev codes (-0.31), n j code lines (+0.30), work rvu (+0.27)
I5022	Chronic systolic (congestive) heart failure	CC	0.417	9305	work rvu (+0.34), or (-0.11), n distinct hcps (+0.07)
M069	Rheumatoid arthritis, unspecified	No CC/MCC	0.364	1302	relative claim charge (+0.58), n distinct hcps (-0.20), n imaging lines (+0.15)
I429	Cardiomyopathy, unspecified	CC	0.336	4976	n distinct rev codes (-0.39), relative claim charge (+0.39), work rvu (+0.14)
I350	Nonrheumatic aortic (valve) stenosis	No CC/MCC	0.275	1947	relative claim charge (+0.40), n imaging lines (+0.15), n distinct rev codes (-0.11)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	0.269	1391	relative claim charge (+0.16), transfusion (-0.11), n distinct rev codes (+0.09)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	0.246	36196	relative claim charge (+0.09), work rvu (+0.08), transfusion (-0.04)
I440	Atrioventricular block, first degree	No CC/MCC	0.231	4649	work rvu (+0.34), n distinct rev codes (+0.27), n j code lines (-0.26)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	0.215	3941	n distinct hcps (+0.17), relative claim charge (+0.17), organ system count (-0.06)
I428	Other cardiomyopathies	CC	0.176	8132	n distinct rev codes (-0.39), work rvu (+0.29), n j code lines (+0.13)

Tier 4 (n=48 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I517	Cardiomegaly	No CC/MCC	2.141	1581	n imaging lines (+0.95), work rvu (+0.49), transfusion (+0.27)
I081	Rheumatic disorders of both mitral and tricuspid valves	No CC/MCC	2.130	3920	work rvu (+0.57), relative claim charge (+0.37), n distinct rev codes (+0.35)
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	2.011	5664	work rvu (+0.60), relative claim charge (+0.58), n distinct rev codes (+0.39)
I25119	Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris	No CC/MCC	1.832	707	n distinct rev codes (+0.69), n imaging lines (+0.51), or (+0.33)
I495	Sick sinus syndrome	No CC/MCC	1.746	8027	work rvu (+0.59), relative claim charge (+0.41), n distinct rev codes (+0.36)
I4820	Chronic atrial fibrillation, unspecified	CC	1.712	714	relative claim charge (+0.55), n imaging lines (+0.45), n distinct hcps (+0.39)
I119	Hypertensive heart disease without heart failure	No CC/MCC	1.636	4030	n imaging lines (+0.59), work rvu (+0.34), n distinct rev codes (+0.26)
I080	Rheumatic disorders of both mitral and aortic valves	No CC/MCC	1.617	1205	work rvu (+0.61), n j code lines (+0.39), n distinct rev codes (+0.24)
I5032	Chronic diastolic (congestive) heart failure	CC	1.615	5641	work rvu (+0.43), relative claim charge (+0.37), n distinct rev codes (+0.26)
I371	Nonrheumatic pulmonary valve insufficiency	No CC/MCC	1.602	667	n distinct rev codes (+0.87), work rvu (+0.83), n j code lines (-0.82)

Tier 5 (n=7 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I4811	Longstanding persistent atrial fibrillation	CC	4.414	4411	work rvu (+1.28), relative claim charge (+1.21), n j code lines (+0.54)
I700	Atherosclerosis of aorta	No CC/MCC	4.412	2231	n imaging lines (+1.36), work rvu (+1.07), n distinct rev codes (+1.00)
I484	Atypical atrial flutter	CC	3.972	13884	work rvu (+1.89), relative claim charge (+1.32), n j code lines (+0.49)
D6869	Other thrombophilia	CC	3.168	632	n j code lines (+1.48), relative claim charge (+1.40), n distinct rev codes (+0.69)
I4819	Other persistent atrial fibrillation	CC	3.163	57772	work rvu (+1.03), relative claim charge (+0.78), n j code lines (+0.61)
I083	Combined rheumatic disorders of mitral, aortic and tricuspid valves	No CC/MCC	2.704	1937	work rvu (+0.73), n distinct rev codes (+0.57), transfusion (+0.32)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	2.606	1988	relative claim charge (+0.65), work rvu (+0.62), n j code lines (+0.37)

Key Driver Frequency

feature	count	pct
work rvu	89	67.400
n distinct rev codes	74	56.100
relative claim charge	74	56.100
n j code lines	49	37.100
n imaging lines	47	35.600
n distinct hcps	35	26.500
or	13	9.800
transfusion	12	9.100
icu	2	1.500
organ system count	1	0.800

PCS Codes

Data Overview

65 total codes in komodo_rii; 3 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 61.9% of variance; PC1+PC2 together explain 100.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	work rvu	n j code lines	organ system count	n distinct hcps	relative claim charge	or	icu
1	1.000	1069.000	10.217	19.730	8.431	1.338	0.940	0.850	0.006	0.009
2	1.000	851.000	10.314	24.702	10.031	1.272	0.989	1.224	0.000	0.000
3	1.000	577.000	5.184	21.382	8.994	2.212	0.350	1.108	0.061	0.000

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_organ_system_count	0.397	-0.500
rate_or	0.396	-0.500
avg_relative_claim_charge	0.123	-0.500
avg_length_of_stay	0.000	nan
rate_dialysis	0.000	nan
rate_mechanical_ventilation	0.000	nan
rate_multiple_or_days	0.000	nan
avg_n_j_code_lines	-0.030	-0.500
avg_work_rvu	-0.038	-0.500
rate_icu	-0.233	0.866
avg_n_imaging_lines	-0.385	1.000
rate_transfusion	-0.386	0.500
avg_n_distinct_hcps	-0.396	0.500
avg_n_distinct_rev_codes	-0.399	0.500

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=1 codes)

code	Description	Score	N claims	Key drivers
02583ZZ	DESTRUCTION OF CONDUCTION MECHANISM, PERCUTANEOUS APPROACH	-2.042	1069	n imaging lines (-0.43), icu (-0.33), n distinct rev codes (-0.27)

Tier 2 (n=1 codes)

code	Description	Score	N claims	Key drivers
02583ZF	None	-1.461	851	transfusion (-0.36), or (-0.32), n distinct hcps (-0.31)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
4A02X4A	MEASUREMENT OF CARDIAC ELECTRICAL ACTIVITY, GUIDANCE, EXTERNAL APPROACH	3.503	577	n distinct rev codes (+0.56), organ system count (+0.56), n distinct hcps (+0.56)

Key Driver Frequency

feature	count	pct
n distinct hcps	2	66.700
n distinct rev codes	2	66.700
transfusion	1	33.300
or	1	33.300
n imaging lines	1	33.300
icu	1	33.300
organ system count	1	33.300