OP - RA.0.PET

CM Codes

Data Overview

11307 total codes in komodo_rii; 320 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	197
CC	119
MCC	4

PCA Analysis

PC1 explains 34.5% of variance; PC1+PC2 together explain 48.9%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	organ system count	work rvu	n j code lines	n imaging lines	relative claim charge	n distinct hcps	or
1	175.000	1058621.000	2.742	1.914	2.905	0.154	0.077	0.990	0.713	0.002
2	101.000	577145.000	3.083	2.034	3.130	0.219	0.130	1.027	0.743	0.005
3	44.000	126628.000	4.072	3.146	3.350	0.441	0.170	1.079	0.760	0.010

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	78	35	6	119
MCC	2	2	0	4
No CC/MCC	95	64	38	197
All	175	101	44	320

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.468	-0.150	0.025
avg_n_j_code_lines	0.412	-0.107	0.009
avg_work_rvu	0.400	-0.042	-0.038
rate_or	0.322	-0.077	-0.197
avg_n_imaging_lines	0.296	0.057	0.018
rate_transfusion	0.288	-0.019	0.202
avg_organ_system_count	0.244	-0.113	-0.372
avg_relative_claim_charge	0.244	-0.103	-0.153
avg_n_distinct_hcps	0.191	-0.088	-0.051
rate_dialysis	0.130	0.036	0.068
rate_icu	0.065	0.077	0.034
avg_length_of_stay	-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 (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E8342	Hypomagnesemia	No CC/MCC	7.060	3	1231	n distinct rev codes (+1.65), n j code lines (+1.45), transfusion (+1.15)
E876	Hypokalemia	No CC/MCC	7.008	3	1224	n distinct rev codes (+1.58), n j code lines (+1.50), or (+1.21)
D6481	Anemia due to antineoplastic chemotherapy	No CC/MCC	5.656	3	1656	transfusion (+2.88), n distinct rev codes (+1.01), n j code lines (+1.00)
D630	Anemia in neoplastic disease	No CC/MCC	5.355	3	1606	transfusion (+1.63), dialysis (+1.07), n distinct rev codes (+0.86)
G629	Polyneuropathy, unspecified	No CC/MCC	5.352	3	2449	n distinct rev codes (+1.57), or (+1.49), work rvu (+0.51)

Under-tiered: Tier 1, MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J9859	Other diseases of mediastinum, not elsewhere classified	MCC	-1.411	1	3903	n distinct rev codes (-0.35), or (-0.21), work rvu (-0.20)
J181	Lobar pneumonia, unspecified organism	MCC	-1.277	1	1956	n distinct hcps (+0.42), work rvu (-0.40), relative claim charge (-0.32)

Top Codes by Tier

Tier 1 (n=175 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C7A8	Other malignant neuroendocrine tumors	CC	-0.410	5087	relative claim charge (+1.32), n distinct rev codes (-0.61), n distinct hcps (-0.45)
C169	Malignant neoplasm of stomach, unspecified	CC	-0.426	3922	n imaging lines (+0.23), organ system count (-0.20), or (-0.16)
C7951	Secondary malignant neoplasm of bone	CC	-0.435	72710	or (-0.18), organ system count (-0.16), n distinct rev codes (-0.12)
J9811	Atelectasis	CC	-0.442	10929	n distinct rev codes (-0.36), organ system count (+0.31), n j code lines (-0.27)
C7972	Secondary malignant neoplasm of left adrenal gland	CC	-0.472	2819	or (-0.17), organ system count (-0.13), n j code lines (-0.10)
C7A1	Malignant poorly differentiated neuroendocrine tumors	CC	-0.476	1613	relative claim charge (+0.28), n distinct hcps (-0.27), n distinct rev codes (-0.19)
K769	Liver disease, unspecified	No CC/MCC	-0.488	11661	n distinct rev codes (-0.22), or (-0.14), n j code lines (-0.13)
I2584	Coronary atherosclerosis due to calcified coronary lesion	No CC/MCC	-0.519	1653	work rvu (-0.50), n j code lines (+0.30), organ system count (+0.29)
C786	Secondary malignant neoplasm of retroperitoneum and peritoneum	CC	-0.520	7745	organ system count (-0.15), work rvu (-0.10), n distinct hcps (+0.09)
C19	Malignant neoplasm of rectosigmoid junction	CC	-0.524	3280	n imaging lines (+0.24), or (-0.21), n distinct rev codes (-0.20)

Tier 2 (n=101 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D649	Anemia, unspecified	No CC/MCC	1.993	7370	transfusion (+0.81), n distinct rev codes (+0.46), work rvu (+0.19)
E890	Postprocedural hypothyroidism	No CC/MCC	1.952	2940	n distinct rev codes (+0.65), n imaging lines (+0.42), or (+0.30)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	1.866	2175	n distinct rev codes (+0.73), n j code lines (+0.62), organ system count (+0.37)
C7931	Secondary malignant neoplasm of brain	CC	1.799	17472	n imaging lines (+0.68), work rvu (+0.68), relative claim charge (+0.23)
C300	Malignant neoplasm of nasal cavity	No CC/MCC	1.706	1642	work rvu (+0.70), n imaging lines (+0.53), n j code lines (+0.38)
E782	Mixed hyperlipidemia	No CC/MCC	1.676	2142	n j code lines (+1.44), n distinct rev codes (+0.73), work rvu (-0.34)
L988	Other specified disorders of the skin and subcutaneous tissue	No CC/MCC	1.646	1271	n distinct hcps (+0.45), work rvu (+0.44), n distinct rev codes (+0.30)
C069	Malignant neoplasm of mouth, unspecified	No CC/MCC	1.543	2336	or (+0.87), n imaging lines (+0.42), work rvu (+0.32)
L989	Disorder of the skin and subcutaneous tissue, unspecified	No CC/MCC	1.501	1657	or (+0.74), n distinct rev codes (+0.27), work rvu (+0.25)
C9001	Multiple myeloma in remission	CC	1.369	3828	work rvu (+0.91), n imaging lines (+0.44), relative claim charge (+0.24)

Tier 3 (n=44 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D849	Immunodeficiency, unspecified	CC	10.266	1741	work rvu (+2.37), n imaging lines (+2.00), n distinct rev codes (+1.81)
E8342	Hypomagnesemia	No CC/MCC	7.060	1231	n distinct rev codes (+1.65), n j code lines (+1.45), transfusion (+1.15)
E876	Hypokalemia	No CC/MCC	7.008	1224	n distinct rev codes (+1.58), n j code lines (+1.50), or (+1.21)
C419	Malignant neoplasm of bone and articular cartilage, unspecified	CC	6.092	3123	n imaging lines (+2.06), work rvu (+1.41), n j code lines (+1.06)
D6481	Anemia due to antineoplastic chemotherapy	No CC/MCC	5.656	1656	transfusion (+2.88), n distinct rev codes (+1.01), n j code lines (+1.00)
D801	Nonfamilial hypogammaglobulinemia	CC	5.625	1641	n distinct rev codes (+1.62), n j code lines (+0.96), or (+0.83)
D630	Anemia in neoplastic disease	No CC/MCC	5.355	1606	transfusion (+1.63), dialysis (+1.07), n distinct rev codes (+0.86)
G629	Polyneuropathy, unspecified	No CC/MCC	5.352	2449	n distinct rev codes (+1.57), or (+1.49), work rvu (+0.51)
F32A	Depression, unspecified	No CC/MCC	5.285	1756	or (+1.26), n distinct rev codes (+1.24), work rvu (+0.81)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	5.029	4428	n distinct rev codes (+1.46), or (+1.32), organ system count (+0.62)

Key Driver Frequency

feature	count	pct
n distinct rev codes	215	67.200
organ system count	159	49.700
n j code lines	147	45.900
work rvu	138	43.100
or	112	35.000
n imaging lines	82	25.600
n distinct hcps	64	20.000
relative claim charge	21	6.600
transfusion	16	5.000
dialysis	4	1.200
icu	2	0.600