OP - RA.0.echocardiography

CM Codes

Data Overview

18393 total codes in komodo_rii; 203 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	139
CC	48
MCC	16

PCA Analysis

PC1 explains 56.1% of variance; PC1+PC2 together explain 65.9%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	organ system count	work rvu	n j code lines	relative claim charge	n distinct hcps	n imaging lines	transfusion
1	133.000	7375066.000	2.027	1.391	1.999	0.208	1.040	0.701	0.051	0.000
2	50.000	1537183.000	3.182	2.424	2.563	0.616	1.241	0.640	0.112	0.001
3	20.000	309974.000	4.726	3.599	3.138	1.102	1.492	0.487	0.188	0.005

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	34	11	3	48
MCC	11	5	0	16
No CC/MCC	88	34	17	139
All	133	50	20	203

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.370	-0.203	0.031
avg_n_j_code_lines	0.345	0.024	-0.166
avg_relative_claim_charge	0.339	-0.205	-0.076
avg_work_rvu	0.329	-0.206	-0.020
avg_organ_system_count	0.326	-0.120	-0.196
rate_icu	0.313	-0.063	0.082
avg_n_imaging_lines	0.250	-0.147	-0.213
rate_transfusion	0.241	-0.206	0.045
rate_or	0.206	-0.126	-0.120
rate_dialysis	0.174	0.167	0.014
rate_mechanical_ventilation	0.162	0.192	0.008
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
avg_n_distinct_hcps	-0.311	-0.007	0.084

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
D631	Anemia in chronic kidney disease	No CC/MCC	9.257	3	5727	dialysis (+2.02), transfusion (+1.29), icu (+1.05)
E876	Hypokalemia	No CC/MCC	8.523	3	11232	icu (+1.26), n distinct hcps (+1.19), n distinct rev codes (+1.09)
F32A	Depression, unspecified	No CC/MCC	7.138	3	11921	icu (+1.15), work rvu (+0.99), n j code lines (+0.93)
E8342	Hypomagnesemia	No CC/MCC	6.880	3	7619	mechanical ventilation (+1.29), n distinct rev codes (+1.07), icu (+0.76)
I160	Hypertensive urgency	No CC/MCC	6.847	3	6901	n distinct hcps (+1.61), icu (+1.15), n distinct rev codes (+1.07)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
Q244	Congenital subaortic stenosis	MCC	-1.678	1	6877	organ system count (-0.41), n j code lines (-0.25), n distinct hcps (-0.24)
Q203	Discordant ventriculoarterial connection	MCC	-1.534	1	12608	organ system count (-0.45), n j code lines (-0.32), n imaging lines (-0.18)
Q213	Tetralogy of Fallot	MCC	-1.411	1	22063	organ system count (-0.44), n j code lines (-0.33), n distinct rev codes (-0.21)
I5021	Acute systolic (congestive) heart failure	MCC	-1.344	1	9562	relative claim charge (-0.44), work rvu (-0.38), icu (+0.36)
Q256	Stenosis of pulmonary artery	MCC	-1.287	1	15250	organ system count (-0.46), n j code lines (-0.29), n distinct hcps (-0.18)

Top Codes by Tier

Tier 1 (n=133 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I6529	Occlusion and stenosis of unspecified carotid artery	No CC/MCC	-0.055	8126	relative claim charge (+0.17), transfusion (-0.11), n j code lines (-0.09)
J849	Interstitial pulmonary disease, unspecified	CC	-0.116	14948	n imaging lines (+0.59), n distinct hcps (-0.44), n j code lines (-0.28)
I4821	Permanent atrial fibrillation	CC	-0.128	25401	n j code lines (+0.20), n imaging lines (-0.17), work rvu (-0.13)
I951	Orthostatic hypotension	No CC/MCC	-0.173	12069	relative claim charge (-0.26), n distinct hcps (+0.26), or (-0.11)
I480	Paroxysmal atrial fibrillation	No CC/MCC	-0.177	256837	n j code lines (+0.24), n imaging lines (-0.15), organ system count (-0.09)
I495	Sick sinus syndrome	No CC/MCC	-0.191	24486	n j code lines (+0.16), n imaging lines (-0.15), icu (-0.10)
I872	Venous insufficiency (chronic) (peripheral)	No CC/MCC	-0.265	9971	or (+0.26), icu (-0.20), n distinct hcps (-0.14)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	-0.270	9506	relative claim charge (-0.27), work rvu (-0.21), n imaging lines (-0.15)
I4811	Longstanding persistent atrial fibrillation	CC	-0.327	15568	n j code lines (+0.26), icu (-0.16), n imaging lines (-0.14)
Q250	Patent ductus arteriosus	CC	-0.352	21123	mechanical ventilation (+0.74), organ system count (-0.53), n j code lines (-0.29)

Tier 2 (n=50 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E039	Hypothyroidism, unspecified	No CC/MCC	3.519	44012	n distinct rev codes (+0.65), n j code lines (+0.58), work rvu (+0.48)
J439	Emphysema, unspecified	No CC/MCC	3.505	8375	n imaging lines (+0.98), relative claim charge (+0.42), organ system count (+0.40)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	3.487	19107	n j code lines (+0.57), work rvu (+0.56), organ system count (+0.53)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	3.478	19655	n distinct rev codes (+0.66), organ system count (+0.64), n j code lines (+0.58)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	3.046	14499	n distinct rev codes (+0.61), n distinct hcps (+0.58), organ system count (+0.41)
N186	End stage renal disease	MCC	2.956	19865	dialysis (+1.16), relative claim charge (+0.31), n distinct rev codes (+0.30)
N189	Chronic kidney disease, unspecified	No CC/MCC	2.667	21832	organ system count (+0.59), n distinct rev codes (+0.53), n j code lines (+0.53)
N184	Chronic kidney disease, stage 4 (severe)	CC	2.428	10028	n distinct rev codes (+0.48), organ system count (+0.47), transfusion (+0.40)
I483	Typical atrial flutter	CC	2.405	11531	work rvu (+1.76), n j code lines (+1.04), n distinct hcps (+0.26)
E669	Obesity, unspecified	No CC/MCC	2.335	46087	n j code lines (+0.54), work rvu (+0.45), organ system count (+0.37)

Tier 3 (n=20 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N179	Acute kidney failure, unspecified	CC	10.149	12676	icu (+1.51), n distinct hcps (+1.48), n distinct rev codes (+1.33)
E871	Hypo-osmolality and hyponatremia	CC	9.813	6350	icu (+1.43), relative claim charge (+1.36), n distinct hcps (+1.17)
D631	Anemia in chronic kidney disease	No CC/MCC	9.257	5727	dialysis (+2.02), transfusion (+1.29), icu (+1.05)
E876	Hypokalemia	No CC/MCC	8.523	11232	icu (+1.26), n distinct hcps (+1.19), n distinct rev codes (+1.09)
F32A	Depression, unspecified	No CC/MCC	7.138	11921	icu (+1.15), work rvu (+0.99), n j code lines (+0.93)
E8342	Hypomagnesemia	No CC/MCC	6.880	7619	mechanical ventilation (+1.29), n distinct rev codes (+1.07), icu (+0.76)
I160	Hypertensive urgency	No CC/MCC	6.847	6901	n distinct hcps (+1.61), icu (+1.15), n distinct rev codes (+1.07)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	6.209	8097	relative claim charge (+1.04), n distinct rev codes (+1.01), n j code lines (+0.84)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	6.171	24696	icu (+0.98), work rvu (+0.88), relative claim charge (+0.83)
D649	Anemia, unspecified	No CC/MCC	5.607	20954	transfusion (+1.73), n distinct rev codes (+0.67), organ system count (+0.58)

Key Driver Frequency

feature	count	pct
n distinct rev codes	106	52.200
relative claim charge	103	50.700
work rvu	91	44.800
n j code lines	88	43.300
organ system count	70	34.500
n distinct hcps	52	25.600
icu	39	19.200
n imaging lines	38	18.700
transfusion	7	3.400
or	6	3.000
mechanical ventilation	6	3.000
dialysis	3	1.500