OP - RA.0.mre
CM Codes
Data Overview
1458 total codes in komodo_rii; 4 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 4 |
PCA Analysis
PC1 explains 78.8% of variance; PC1+PC2 together explain 95.6%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | work rvu | n distinct rev codes | n imaging lines | relative claim charge | organ system count | n j code lines | n distinct hcps | or |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1.000 | 1247.000 | 1.611 | 1.259 | 1.026 | 0.947 | 1.330 | 0.075 | 0.659 | 0.000 |
| 2 | 2.000 | 5648.000 | 1.603 | 1.247 | 1.048 | 0.982 | 1.333 | 0.072 | 0.680 | 0.000 |
| 3 | 1.000 | 533.000 | 1.854 | 1.449 | 1.158 | 1.008 | 1.380 | 0.119 | 0.700 | 0.000 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| No CC/MCC | 1 | 2 | 1 | 4 |
| All | 1 | 2 | 1 | 4 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_imaging_lines | 0.398 | -0.400 | nan |
| avg_organ_system_count | 0.392 | -1.000 | nan |
| avg_n_distinct_rev_codes | 0.389 | -0.800 | nan |
| avg_n_j_code_lines | 0.387 | -0.800 | nan |
| avg_work_rvu | 0.380 | -0.200 | nan |
| avg_n_distinct_hcps | 0.346 | -0.400 | nan |
| avg_relative_claim_charge | 0.336 | -0.800 | nan |
| avg_length_of_stay | 0.000 | nan | nan |
| rate_dialysis | 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 |
| rate_transfusion | 0.000 | nan | nan |
| rate_or | -0.095 | 0.775 | 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 (1 codes)
| code | code_description | cms_severity | intensity_score | tier | n_claims | key_drivers |
|---|---|---|---|---|---|---|
| K7460 | Unspecified cirrhosis of liver | No CC/MCC | 4.293 | 3 | 533 | n imaging lines (+0.68), organ system count (+0.67), n distinct rev codes (+0.67) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=1 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| K7400 | Hepatic fibrosis, unspecified | No CC/MCC | -2.082 | 1247 | relative claim charge (-0.51), n distinct hcps (-0.47), n imaging lines (-0.34) |
Tier 2 (n=2 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| K760 | Fatty (change of) liver, not elsewhere classified | No CC/MCC | -1.042 | 4741 | organ system count (-0.27), n j code lines (-0.27), n distinct rev codes (-0.25) |
| K7581 | Nonalcoholic steatohepatitis (NASH) | No CC/MCC | -1.169 | 907 | work rvu (-0.36), n distinct rev codes (-0.24), n j code lines (-0.22) |
Tier 3 (n=1 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| K7460 | Unspecified cirrhosis of liver | No CC/MCC | 4.293 | 533 | n imaging lines (+0.68), organ system count (+0.67), n distinct rev codes (+0.67) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n distinct rev codes | 3 | 75.000 |
| organ system count | 2 | 50.000 |
| n j code lines | 2 | 50.000 |
| n imaging lines | 2 | 50.000 |
| relative claim charge | 1 | 25.000 |
| n distinct hcps | 1 | 25.000 |
| work rvu | 1 | 25.000 |
