OP - RE.0.hysteroscopy
CM Codes
Data Overview
5596 total codes in komodo_rii; 150 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 146 |
| CC | 4 |
PCA Analysis
PC1 explains 34.0% of variance; PC1+PC2 together explain 51.6%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | work rvu | organ system count | n j code lines | n distinct rev codes | or | n distinct hcps | relative claim charge | transfusion |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 102.000 | 702414.000 | 5.643 | 3.980 | 6.952 | 7.478 | 0.871 | 0.723 | 1.005 | 0.003 |
| 2 | 45.000 | 237229.000 | 6.769 | 2.676 | 7.198 | 7.167 | 0.776 | 0.676 | 1.049 | 0.004 |
| 3 | 3.000 | 3214.000 | 11.852 | 2.312 | 8.314 | 6.178 | 0.479 | 0.406 | 1.182 | 0.004 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 3 | 1 | 0 | 4 |
| No CC/MCC | 99 | 44 | 3 | 146 |
| All | 102 | 45 | 3 | 150 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_work_rvu | 0.457 | -0.075 | 0.107 |
| avg_relative_claim_charge | 0.320 | -0.085 | 0.103 |
| avg_n_j_code_lines | 0.277 | -0.018 | -0.126 |
| rate_transfusion | 0.094 | 0.171 | 0.149 |
| avg_n_imaging_lines | 0.054 | 0.278 | 0.048 |
| avg_length_of_stay | 0.000 | nan | nan |
| rate_mechanical_ventilation | 0.000 | nan | nan |
| rate_multiple_or_days | 0.000 | nan | nan |
| rate_icu | -0.028 | 0.268 | -0.034 |
| rate_dialysis | -0.069 | 0.280 | 0.104 |
| avg_n_distinct_rev_codes | -0.318 | -0.007 | 0.090 |
| avg_organ_system_count | -0.329 | -0.105 | 0.024 |
| avg_n_distinct_hcps | -0.395 | -0.094 | -0.170 |
| rate_or | -0.480 | -0.101 | 0.072 |
Top 6 Tier-Discriminating Features
Bottom 6 Tier-Discriminating Features
Score Validation
Misclassification Audit (N=10 samples)
Over-tiered: Tier 3, No CC/MCC (3 codes)
| code | code_description | cms_severity | intensity_score | tier | n_claims | key_drivers |
|---|---|---|---|---|---|---|
| N838 | Other noninflammatory disorders of ovary, fallopian tube and broad ligament | No CC/MCC | 12.211 | 3 | 1239 | work rvu (+3.08), or (+2.90), n distinct hcps (+2.46) |
| N8000 | Endometriosis of the uterus, unspecified | No CC/MCC | 7.858 | 3 | 502 | or (+1.71), work rvu (+1.69), n distinct hcps (+1.47) |
| N736 | Female pelvic peritoneal adhesions (postinfective) | No CC/MCC | 7.110 | 3 | 1473 | or (+1.72), work rvu (+1.60), n distinct hcps (+1.38) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=102 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| D649 | Anemia, unspecified | No CC/MCC | 0.263 | 12384 | transfusion (+0.41), relative claim charge (+0.23), n distinct rev codes (-0.19) |
| N710 | Acute inflammatory disease of uterus | CC | 0.215 | 507 | relative claim charge (-0.39), n distinct hcps (+0.34), organ system count (+0.31) |
| N8110 | Cystocele, unspecified | No CC/MCC | 0.183 | 1370 | organ system count (+0.23), n j code lines (-0.17), n distinct rev codes (+0.13) |
| Q513 | Bicornate uterus | No CC/MCC | 0.155 | 537 | organ system count (+0.44), work rvu (-0.18), transfusion (-0.11) |
| N816 | Rectocele | No CC/MCC | 0.134 | 1037 | organ system count (+0.18), work rvu (+0.16), or (-0.15) |
| N8502 | Endometrial intraepithelial neoplasia [EIN] | No CC/MCC | 0.081 | 3981 | organ system count (+0.24), relative claim charge (+0.23), work rvu (-0.19) |
| E063 | Autoimmune thyroiditis | No CC/MCC | 0.007 | 1561 | n distinct rev codes (+0.28), or (+0.27), relative claim charge (-0.24) |
| N841 | Polyp of cervix uteri | No CC/MCC | 0.006 | 16733 | organ system count (+0.38), work rvu (-0.19), n j code lines (-0.11) |
| G8929 | Other chronic pain | No CC/MCC | 0.003 | 3046 | organ system count (-0.43), n distinct hcps (+0.16), n j code lines (+0.15) |
| N840 | Polyp of corpus uteri | No CC/MCC | -0.027 | 134879 | organ system count (+0.37), work rvu (-0.23), relative claim charge (-0.18) |
Tier 2 (n=45 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| N9410 | Unspecified dyspareunia | No CC/MCC | 4.569 | 907 | or (+1.26), n distinct hcps (+0.98), work rvu (+0.80) |
| N809 | Endometriosis, unspecified | No CC/MCC | 4.505 | 926 | or (+1.17), work rvu (+0.84), n distinct hcps (+0.78) |
| N83202 | Unspecified ovarian cyst, left side | No CC/MCC | 4.085 | 1422 | or (+1.11), work rvu (+0.99), n distinct hcps (+0.89) |
| N83201 | Unspecified ovarian cyst, right side | No CC/MCC | 4.076 | 1447 | or (+1.08), work rvu (+1.01), n distinct hcps (+0.85) |
| D252 | Subserosal leiomyoma of uterus | No CC/MCC | 3.735 | 2289 | work rvu (+0.89), relative claim charge (+0.85), or (+0.72) |
| N393 | Stress incontinence (female) (male) | No CC/MCC | 3.330 | 828 | work rvu (+1.54), relative claim charge (+0.93), n j code lines (+0.28) |
| O034 | Incomplete spontaneous abortion without complication | No CC/MCC | 2.893 | 593 | organ system count (+0.88), or (+0.81), n distinct rev codes (+0.42) |
| D069 | Carcinoma in situ of cervix, unspecified | No CC/MCC | 2.752 | 648 | work rvu (+1.45), relative claim charge (+1.03), transfusion (+0.33) |
| N946 | Dysmenorrhea, unspecified | No CC/MCC | 2.602 | 7678 | or (+0.69), n distinct hcps (+0.44), organ system count (+0.42) |
| D250 | Submucous leiomyoma of uterus | No CC/MCC | 2.325 | 21425 | relative claim charge (+0.89), work rvu (+0.54), n j code lines (+0.27) |
Tier 3 (n=3 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| N838 | Other noninflammatory disorders of ovary, fallopian tube and broad ligament | No CC/MCC | 12.211 | 1239 | work rvu (+3.08), or (+2.90), n distinct hcps (+2.46) |
| N8000 | Endometriosis of the uterus, unspecified | No CC/MCC | 7.858 | 502 | or (+1.71), work rvu (+1.69), n distinct hcps (+1.47) |
| N736 | Female pelvic peritoneal adhesions (postinfective) | No CC/MCC | 7.110 | 1473 | or (+1.72), work rvu (+1.60), n distinct hcps (+1.38) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| organ system count | 96 | 64.000 |
| or | 94 | 62.700 |
| work rvu | 71 | 47.300 |
| n distinct hcps | 51 | 34.000 |
| relative claim charge | 51 | 34.000 |
| n j code lines | 39 | 26.000 |
| n distinct rev codes | 37 | 24.700 |
| transfusion | 6 | 4.000 |
| dialysis | 3 | 2.000 |
| icu | 1 | 0.700 |
| n imaging lines | 1 | 0.700 |
