OP - RA.0.xray

CM Codes

Data Overview

42124 total codes in komodo_rii; 217 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	204
CC	10
MCC	3

PCA Analysis

PC1 explains 52.9% of variance; PC1+PC2 together explain 65.2%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	organ system count	n distinct rev codes	relative claim charge	n j code lines	n distinct hcps	n imaging lines	or
1	156.000	19812130.000	0.754	1.444	1.346	1.224	0.077	0.667	0.008	0.001
2	44.000	3630547.000	1.613	2.482	2.161	1.555	0.367	0.511	0.013	0.003
3	17.000	1067321.000	2.906	3.119	2.328	2.067	0.807	0.372	0.031	0.005

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	7	3	0	10
MCC	1	1	1	3
No CC/MCC	148	40	16	204
All	156	44	17	217

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_j_code_lines	0.363	-0.104	0.218
rate_icu	0.354	-0.008	0.170
avg_work_rvu	0.345	-0.144	0.126
avg_organ_system_count	0.342	-0.092	-0.053
avg_n_distinct_rev_codes	0.312	-0.141	0.090
rate_or	0.278	-0.080	0.043
avg_relative_claim_charge	0.263	-0.075	-0.246
rate_mechanical_ventilation	0.261	0.051	0.257
rate_transfusion	0.221	-0.075	0.115
avg_n_imaging_lines	0.143	-0.052	-0.095
rate_dialysis	0.128	0.130	0.122
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_n_distinct_hcps	-0.331	0.069	-0.212

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
I110	Hypertensive heart disease with heart failure	No CC/MCC	9.872	3	36283	icu (+1.51), mechanical ventilation (+1.51), n j code lines (+1.21)
E876	Hypokalemia	No CC/MCC	9.116	3	41328	mechanical ventilation (+2.08), icu (+1.70), n j code lines (+1.35)
I252	Old myocardial infarction	No CC/MCC	7.906	3	25652	icu (+1.12), n j code lines (+1.10), work rvu (+1.06)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	7.693	3	37375	icu (+1.28), organ system count (+1.17), n distinct rev codes (+0.72)
S0990XA	Unspecified injury of head, initial encounter	No CC/MCC	7.455	3	36774	work rvu (+1.80), n imaging lines (+1.71), mechanical ventilation (+1.31)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J189	Pneumonia, unspecified organism	MCC	-1.018	1	311033	relative claim charge (-0.38), organ system count (-0.23), or (-0.17)

Top Codes by Tier

Tier 1 (n=156 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M5116	Intervertebral disc disorders with radiculopathy, lumbar region	No CC/MCC	0.240	39971	or (+0.46), n j code lines (+0.27), organ system count (-0.20)
C61	Malignant neoplasm of prostate	No CC/MCC	0.173	23429	n distinct rev codes (+0.52), organ system count (+0.26), work rvu (-0.22)
J441	Chronic obstructive pulmonary disease with (acute) exacerbation	CC	0.145	62976	n distinct hcps (+0.41), relative claim charge (-0.35), icu (+0.30)
M2550	Pain in unspecified joint	No CC/MCC	0.114	107686	relative claim charge (+0.88), n distinct rev codes (+0.43), n j code lines (-0.26)
J3489	Other specified disorders of nose and nasal sinuses	No CC/MCC	-0.112	23182	n distinct hcps (+0.20), relative claim charge (-0.17), or (-0.12)
J029	Acute pharyngitis, unspecified	No CC/MCC	-0.125	79868	n distinct rev codes (+0.29), n distinct hcps (+0.19), or (-0.17)
M62838	Other muscle spasm	No CC/MCC	-0.197	26201	or (-0.17), n distinct hcps (+0.13), n j code lines (+0.11)
M4807	Spinal stenosis, lumbosacral region	No CC/MCC	-0.200	24025	n imaging lines (+0.37), transfusion (+0.21), organ system count (-0.19)
M5126	Other intervertebral disc displacement, lumbar region	No CC/MCC	-0.207	25002	transfusion (+0.22), organ system count (-0.21), n imaging lines (+0.20)
M810	Age-related osteoporosis without current pathological fracture	No CC/MCC	-0.239	65825	relative claim charge (+0.21), n distinct rev codes (+0.18), icu (-0.15)

Tier 2 (n=44 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I4891	Unspecified atrial fibrillation	No CC/MCC	4.232	56125	n distinct hcps (+0.63), icu (+0.62), work rvu (+0.61)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	4.206	38561	n distinct hcps (+1.13), work rvu (+1.10), n j code lines (+0.87)
E785	Hyperlipidemia, unspecified	No CC/MCC	4.145	266405	organ system count (+0.74), n distinct rev codes (+0.73), n j code lines (+0.53)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	4.118	120416	icu (+0.70), n distinct rev codes (+0.52), n j code lines (+0.52)
I480	Paroxysmal atrial fibrillation	No CC/MCC	3.916	45847	icu (+1.12), n distinct rev codes (+0.54), or (+0.42)
D509	Iron deficiency anemia, unspecified	No CC/MCC	3.673	31856	transfusion (+1.61), n distinct rev codes (+0.77), organ system count (+0.66)
N390	Urinary tract infection, site not specified	CC	3.572	60926	n distinct rev codes (+0.70), n j code lines (+0.64), work rvu (+0.41)
I5032	Chronic diastolic (congestive) heart failure	CC	3.392	24147	icu (+0.88), mechanical ventilation (+0.48), n distinct rev codes (+0.46)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	3.293	87912	organ system count (+0.72), n distinct rev codes (+0.69), n j code lines (+0.46)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	3.164	85102	organ system count (+0.63), icu (+0.51), n j code lines (+0.50)

Tier 3 (n=17 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I110	Hypertensive heart disease with heart failure	No CC/MCC	9.872	36283	icu (+1.51), mechanical ventilation (+1.51), n j code lines (+1.21)
E876	Hypokalemia	No CC/MCC	9.116	41328	mechanical ventilation (+2.08), icu (+1.70), n j code lines (+1.35)
I252	Old myocardial infarction	No CC/MCC	7.906	25652	icu (+1.12), n j code lines (+1.10), work rvu (+1.06)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	7.693	37375	icu (+1.28), organ system count (+1.17), n distinct rev codes (+0.72)
S0990XA	Unspecified injury of head, initial encounter	No CC/MCC	7.455	36774	work rvu (+1.80), n imaging lines (+1.71), mechanical ventilation (+1.31)
E860	Dehydration	No CC/MCC	7.441	30458	n j code lines (+1.74), icu (+1.64), work rvu (+1.35)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	7.137	34155	organ system count (+1.19), icu (+1.00), n j code lines (+0.87)
F32A	Depression, unspecified	No CC/MCC	6.874	48472	icu (+1.09), n j code lines (+1.04), organ system count (+0.95)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	6.499	64665	or (+1.42), n j code lines (+1.26), organ system count (+0.93)
N186	End stage renal disease	MCC	6.185	28366	dialysis (+1.74), icu (+1.20), transfusion (+0.75)

Key Driver Frequency

feature	count	pct
n j code lines	126	58.100
organ system count	101	46.500
n distinct rev codes	96	44.200
work rvu	87	40.100
n distinct hcps	79	36.400
relative claim charge	59	27.200
icu	39	18.000
or	34	15.700
mechanical ventilation	15	6.900
n imaging lines	9	4.100
transfusion	5	2.300
dialysis	1	0.500