OP - RE.0.hysterectomy

CM Codes

Data Overview

4943 total codes in komodo_rii; 162 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	160
CC	2

PCA Analysis

PC1 explains 29.4% of variance; PC1+PC2 together explain 48.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	organ system count	n distinct rev codes	n distinct hcps	relative claim charge	or	transfusion
1	10.000	34354.000	22.460	12.804	2.827	8.108	0.815	0.967	0.821	0.005
2	68.000	437852.000	23.344	11.575	3.099	8.468	0.698	1.000	0.830	0.005
3	53.000	274517.000	23.864	11.436	4.035	8.713	0.695	1.009	0.869	0.006
4	31.000	69648.000	32.279	11.554	3.755	9.176	0.630	1.117	0.900	0.006

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	0	1	0	1	2
No CC/MCC	10	67	53	30	160
All	10	68	53	31	162

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.526	-0.033	0.098
rate_or	0.407	-0.181	0.012
avg_work_rvu	0.382	-0.256	0.122
avg_relative_claim_charge	0.380	-0.254	0.151
avg_organ_system_count	0.251	-0.006	0.011
rate_dialysis	0.185	0.415	-0.055
avg_n_imaging_lines	0.167	0.305	-0.003
rate_transfusion	0.064	0.111	0.102
avg_length_of_stay	-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
avg_n_j_code_lines	-0.162	-0.048	0.169
avg_n_distinct_hcps	-0.334	-0.001	0.030

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	4.844	4	914	n distinct rev codes (+1.63), dialysis (+1.14), or (+0.95)
N3946	Mixed incontinence	No CC/MCC	4.434	4	1543	relative claim charge (+1.50), work rvu (+1.37), n distinct rev codes (+0.81)
N813	Complete uterovaginal prolapse	No CC/MCC	4.418	4	2871	relative claim charge (+1.48), work rvu (+1.29), n distinct rev codes (+0.93)
N3641	Hypermobility of urethra	No CC/MCC	3.849	4	523	relative claim charge (+1.76), work rvu (+1.42), n distinct rev codes (+0.59)
C55	Malignant neoplasm of uterus, part unspecified	No CC/MCC	3.703	4	586	n distinct rev codes (+1.51), or (+0.66), work rvu (+0.51)

Under-tiered: Tier 1, MCC (0 codes)

None.

Top Codes by Tier

Tier 1 (n=10 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N9410	Unspecified dyspareunia	No CC/MCC	-2.096	3074	or (-0.67), n distinct rev codes (-0.67), relative claim charge (-0.36)
N946	Dysmenorrhea, unspecified	No CC/MCC	-2.108	18067	n distinct rev codes (-0.58), or (-0.42), relative claim charge (-0.37)
N9985	Post endometrial ablation syndrome	No CC/MCC	-2.211	1378	n distinct rev codes (-0.77), or (-0.73), work rvu (-0.40)
D219	Benign neoplasm of connective and other soft tissue, unspecified	No CC/MCC	-2.272	995	n distinct hcps (-0.74), or (-0.64), n distinct rev codes (-0.24)
D261	Other benign neoplasm of corpus uteri	No CC/MCC	-2.508	2173	n distinct hcps (-1.11), n j code lines (-0.56), n distinct rev codes (-0.48)
G8918	Other acute postprocedural pain	No CC/MCC	-2.648	2840	n distinct rev codes (-1.94), or (-1.72), n distinct hcps (+0.52)
F649	Gender identity disorder, unspecified	No CC/MCC	-3.375	739	n distinct rev codes (-0.91), relative claim charge (-0.62), or (-0.46)
D282	Benign neoplasm of uterine tubes and ligaments	No CC/MCC	-3.724	2276	n distinct hcps (-1.85), n j code lines (-0.99), n distinct rev codes (-0.71)
D260	Other benign neoplasm of cervix uteri	No CC/MCC	-4.277	1148	n distinct hcps (-2.11), n j code lines (-1.23), n distinct rev codes (-0.81)
F640	Transsexualism	No CC/MCC	-4.334	1664	n distinct rev codes (-1.48), relative claim charge (-0.65), n distinct hcps (-0.65)

Tier 2 (n=68 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N736	Female pelvic peritoneal adhesions (postinfective)	No CC/MCC	-0.451	19040	work rvu (-0.16), organ system count (-0.15), n distinct hcps (-0.12)
J4520	Mild intermittent asthma, uncomplicated	No CC/MCC	-0.464	1580	organ system count (+0.36), n distinct hcps (-0.28), work rvu (-0.20)
N83292	Other ovarian cyst, left side	No CC/MCC	-0.487	6268	organ system count (-0.14), or (-0.13), n distinct rev codes (-0.13)
N8500	Endometrial hyperplasia, unspecified	No CC/MCC	-0.556	1501	work rvu (-0.28), relative claim charge (-0.19), n distinct hcps (+0.10)
K589	Irritable bowel syndrome, unspecified	No CC/MCC	-0.569	1163	n distinct rev codes (-0.48), organ system count (+0.39), work rvu (-0.19)
F411	Generalized anxiety disorder	No CC/MCC	-0.658	1320	n distinct rev codes (-0.47), organ system count (+0.33), work rvu (-0.30)
E663	Overweight	No CC/MCC	-0.665	558	n distinct rev codes (-0.33), work rvu (-0.15), relative claim charge (-0.14)
D250	Submucous leiomyoma of uterus	No CC/MCC	-0.668	9392	or (-0.36), work rvu (-0.22), organ system count (-0.14)
N80201	Endometriosis of right fallopian tube, unspecified depth	No CC/MCC	-0.674	815	organ system count (-0.20), or (-0.19), work rvu (-0.13)
D269	Other benign neoplasm of uterus, unspecified	No CC/MCC	-0.688	584	n imaging lines (+0.69), or (-0.35), n distinct hcps (-0.26)

Tier 3 (n=53 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E119	Type 2 diabetes mellitus without complications	No CC/MCC	1.513	11107	n distinct rev codes (+0.73), or (+0.28), organ system count (+0.22)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	1.355	4514	n distinct rev codes (+0.54), or (+0.36), organ system count (+0.28)
G4730	Sleep apnea, unspecified	No CC/MCC	1.226	3062	organ system count (+0.46), dialysis (+0.31), or (+0.26)
E782	Mixed hyperlipidemia	No CC/MCC	1.220	1601	n distinct rev codes (+0.48), or (+0.45), organ system count (+0.31)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	1.163	1124	organ system count (+0.47), or (+0.35), n distinct rev codes (+0.32)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	1.050	3153	organ system count (+0.57), n distinct rev codes (+0.36), or (+0.31)
K5900	Constipation, unspecified	No CC/MCC	0.895	636	or (+0.47), n distinct hcps (-0.40), work rvu (+0.28)
I10	Essential (primary) hypertension	No CC/MCC	0.884	33248	n distinct rev codes (+0.29), organ system count (+0.27), or (+0.18)
E559	Vitamin D deficiency, unspecified	No CC/MCC	0.879	1335	organ system count (+0.43), or (+0.42), n distinct rev codes (+0.31)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	0.778	561	organ system count (+0.47), n distinct rev codes (+0.34), or (+0.28)

Tier 4 (n=31 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	4.844	914	n distinct rev codes (+1.63), dialysis (+1.14), or (+0.95)
N3946	Mixed incontinence	No CC/MCC	4.434	1543	relative claim charge (+1.50), work rvu (+1.37), n distinct rev codes (+0.81)
N813	Complete uterovaginal prolapse	No CC/MCC	4.418	2871	relative claim charge (+1.48), work rvu (+1.29), n distinct rev codes (+0.93)
N3641	Hypermobility of urethra	No CC/MCC	3.849	523	relative claim charge (+1.76), work rvu (+1.42), n distinct rev codes (+0.59)
C55	Malignant neoplasm of uterus, part unspecified	No CC/MCC	3.703	586	n distinct rev codes (+1.51), or (+0.66), work rvu (+0.51)
I110	Hypertensive heart disease with heart failure	No CC/MCC	3.495	608	n distinct rev codes (+1.15), n imaging lines (+0.68), or (+0.64)
N83311	Acquired atrophy of right ovary	No CC/MCC	3.263	1302	dialysis (+0.81), n distinct rev codes (+0.73), n imaging lines (+0.52)
N812	Incomplete uterovaginal prolapse	No CC/MCC	3.158	5365	work rvu (+1.20), relative claim charge (+1.13), n distinct hcps (+0.44)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	3.153	551	n distinct rev codes (+1.16), or (+0.95), n distinct hcps (+0.46)
N393	Stress incontinence (female) (male)	No CC/MCC	3.138	6419	relative claim charge (+1.36), work rvu (+1.33), n distinct rev codes (+0.65)

Key Driver Frequency

feature	count	pct
n distinct rev codes	102	63.000
or	100	61.700
work rvu	81	50.000
organ system count	70	43.200
relative claim charge	63	38.900
n distinct hcps	35	21.600
n imaging lines	15	9.300
dialysis	10	6.200
n j code lines	8	4.900
transfusion	2	1.200