IP - BE.1.substance_abuse

CM Codes

Data Overview

14445 total codes in komodo_rii; 370 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	257
CC	98
MCC	15

PCA Analysis

PC1 explains 54.7% of variance; PC1+PC2 together explain 65.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	organ system count	length of stay	n imaging lines	relative claim charge	n j code lines	icu	work rvu
1	186.000	2145283.000	5.857	3.606	5.933	0.227	1.017	0.198	0.095	0.215
2	151.000	963008.000	12.089	5.105	5.318	0.814	1.207	0.466	0.347	0.368
3	33.000	98104.000	16.068	5.750	7.441	1.261	1.855	0.699	0.510	0.538

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	43	42	13	98
MCC	0	5	10	15
No CC/MCC	143	104	10	257
All	186	151	33	370

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.339	-0.056	0.206
rate_icu	0.334	0.006	0.195
rate_or	0.334	-0.037	0.255
avg_n_imaging_lines	0.332	-0.059	0.179
avg_n_j_code_lines	0.327	-0.022	0.159
avg_relative_claim_charge	0.309	-0.185	0.315
avg_organ_system_count	0.294	-0.094	0.086
avg_work_rvu	0.256	-0.171	0.095
rate_mechanical_ventilation	0.246	-0.004	0.217
rate_multiple_or_days	0.231	0.290	0.043
rate_transfusion	0.231	0.020	0.209
rate_dialysis	0.117	0.053	0.213
avg_n_distinct_hcps	0.107	-0.034	0.120
avg_length_of_stay	0.071	-0.147	0.210

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
K7011	Alcoholic hepatitis with ascites	No CC/MCC	7.484	3	1114	or (+1.55), n j code lines (+0.89), multiple or days (+0.85)
G9389	Other specified disorders of brain	No CC/MCC	5.559	3	1042	multiple or days (+0.95), n imaging lines (+0.90), work rvu (+0.60)
K7682	Hepatic encephalopathy	No CC/MCC	5.520	3	3069	multiple or days (+0.76), or (+0.75), relative claim charge (+0.73)
K3189	Other diseases of stomach and duodenum	No CC/MCC	4.676	3	1175	transfusion (+1.20), or (+1.15), n distinct rev codes (+0.51)
K7031	Alcoholic cirrhosis of liver with ascites	No CC/MCC	4.659	3	2736	or (+1.29), transfusion (+0.78), n j code lines (+0.57)

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

None.

Top Codes by Tier

Tier 1 (n=186 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	-0.449	7981	organ system count (+0.31), n j code lines (-0.17), icu (-0.14)
E782	Mixed hyperlipidemia	No CC/MCC	-0.476	4505	multiple or days (+0.25), n j code lines (-0.16), relative claim charge (-0.15)
F1910	Other psychoactive substance abuse, uncomplicated	No CC/MCC	-0.498	6982	work rvu (+0.25), organ system count (-0.23), relative claim charge (-0.22)
F10220	Alcohol dependence with intoxication, uncomplicated	No CC/MCC	-0.500	9908	relative claim charge (-0.24), multiple or days (+0.20), work rvu (-0.14)
G40909	Epilepsy, unspecified, not intractable, without status epilepticus	No CC/MCC	-0.604	20814	relative claim charge (-0.13), work rvu (-0.13), multiple or days (-0.10)
F1590	Other stimulant use, unspecified, uncomplicated	No CC/MCC	-0.623	4361	work rvu (+0.56), organ system count (-0.37), n imaging lines (-0.26)
T426X6A	Underdosing of other antiepileptic and sedative-hypnotic drugs, initial encounter	No CC/MCC	-0.637	916	relative claim charge (-0.26), or (-0.21), n j code lines (-0.14)
I509	Heart failure, unspecified	No CC/MCC	-0.640	4549	icu (-0.15), n imaging lines (-0.10), n distinct rev codes (-0.10)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	-0.681	23320	organ system count (+0.23), n j code lines (-0.16), or (-0.12)
L03114	Cellulitis of left upper limb	CC	-0.693	1135	icu (-0.16), n imaging lines (-0.14), n distinct rev codes (-0.14)

Tier 2 (n=151 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I161	Hypertensive emergency	CC	3.597	1141	icu (+0.70), n imaging lines (+0.57), n distinct rev codes (+0.49)
E43	Unspecified severe protein-calorie malnutrition	MCC	3.532	6311	n distinct rev codes (+0.49), relative claim charge (+0.49), n j code lines (+0.48)
I2489	Other forms of acute ischemic heart disease	No CC/MCC	3.496	1346	multiple or days (+0.73), icu (+0.53), n imaging lines (+0.53)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	3.488	3232	n j code lines (+0.58), transfusion (+0.47), n distinct rev codes (+0.41)
E873	Alkalosis	CC	3.462	2281	icu (+0.54), or (+0.46), n j code lines (+0.44)
K8020	Calculus of gallbladder without cholecystitis without obstruction	No CC/MCC	3.365	1747	n j code lines (+0.55), multiple or days (+0.51), n imaging lines (+0.44)
S0101XA	Laceration without foreign body of scalp, initial encounter	No CC/MCC	3.211	1061	n imaging lines (+1.01), n distinct rev codes (+0.48), icu (+0.35)
F10931	Alcohol use, unspecified with withdrawal delirium	No CC/MCC	3.158	2543	work rvu (+0.88), n j code lines (+0.86), icu (+0.58)
G929	Unspecified toxic encephalopathy	No CC/MCC	3.139	2930	icu (+0.61), n imaging lines (+0.54), n distinct rev codes (+0.41)
I959	Hypotension, unspecified	No CC/MCC	3.107	5986	n j code lines (+0.38), icu (+0.33), work rvu (+0.31)

Tier 3 (n=33 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	11.635	1266	mechanical ventilation (+2.14), relative claim charge (+1.59), or (+1.46)
A419	Sepsis, unspecified organism	MCC	11.005	2154	relative claim charge (+1.73), n j code lines (+1.60), or (+1.49)
N170	Acute kidney failure with tubular necrosis	MCC	10.219	978	relative claim charge (+1.52), or (+1.49), multiple or days (+1.00)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	9.906	1135	mechanical ventilation (+2.94), or (+1.70), icu (+1.20)
D62	Acute posthemorrhagic anemia	CC	9.556	2135	transfusion (+2.81), or (+1.53), multiple or days (+0.89)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.286	5819	relative claim charge (+1.55), or (+1.38), mechanical ventilation (+1.24)
J9601	Acute respiratory failure with hypoxia	MCC	8.391	9861	mechanical ventilation (+1.35), relative claim charge (+1.21), or (+1.15)
K7011	Alcoholic hepatitis with ascites	No CC/MCC	7.484	1114	or (+1.55), n j code lines (+0.89), multiple or days (+0.85)
F05	Delirium due to known physiological condition	CC	6.962	2035	relative claim charge (+1.29), n j code lines (+0.98), n imaging lines (+0.72)
J9811	Atelectasis	CC	6.777	2051	relative claim charge (+0.88), or (+0.85), n j code lines (+0.84)

Key Driver Frequency

feature	count	pct
n distinct rev codes	203	54.900
icu	184	49.700
n imaging lines	158	42.700
n j code lines	148	40.000
organ system count	148	40.000
relative claim charge	77	20.800
work rvu	70	18.900
or	52	14.100
multiple or days	38	10.300
transfusion	15	4.100
n distinct hcps	6	1.600
mechanical ventilation	6	1.600
dialysis	3	0.800
length of stay	2	0.500

PCS Codes

Data Overview

1754 total codes in komodo_rii; 46 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 63.3% of variance; PC1+PC2 together explain 74.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	n imaging lines	icu	n j code lines	mechanical ventilation
1	35.000	326993.000	5.676	8.711	1.202	3.177	0.104	0.027	0.279	0.001
2	9.000	18863.000	18.867	7.379	2.266	5.494	1.478	0.639	0.644	0.406
3	2.000	3361.000	22.400	13.606	4.385	6.162	1.629	0.848	1.017	0.701

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
rate_icu	0.322	-0.362
avg_n_distinct_rev_codes	0.319	-0.445
avg_organ_system_count	0.317	-0.094
avg_n_imaging_lines	0.314	-0.491
rate_or	0.311	-0.372
avg_relative_claim_charge	0.301	0.010
rate_dialysis	0.289	-0.162
avg_work_rvu	0.287	-0.219
rate_multiple_or_days	0.274	-0.083
rate_mechanical_ventilation	0.270	-0.272
avg_n_j_code_lines	0.255	-0.449
rate_transfusion	0.151	-0.193
avg_n_distinct_hcps	0.072	0.071
avg_length_of_stay	0.044	0.170

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=35 codes)

code	Description	Score	N claims	Key drivers
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.028	1524	n j code lines (+0.50), relative claim charge (-0.23), multiple or days (+0.16)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.309	967	n j code lines (+0.45), relative claim charge (-0.23), work rvu (-0.21)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-0.642	1090	relative claim charge (-0.14), dialysis (-0.13), or (-0.13)
HZ32ZZZ	INDIVIDUAL COUNSELING FOR SUBSTANCE ABUSE TREATMENT, COGNITIVE-BEHAVIORAL	-0.789	2171	work rvu (+0.64), organ system count (-0.25), icu (-0.19)
HZ34ZZZ	INDIVIDUAL COUNSELING FOR SUBSTANCE ABUSE TREATMENT, INTERPERSONAL	-0.916	4013	n distinct hcps (+0.28), n j code lines (+0.27), n imaging lines (-0.20)
HZ31ZZZ	INDIVIDUAL COUNSELING FOR SUBSTANCE ABUSE TREATMENT, BEHAVIORAL	-0.930	3352	n j code lines (+0.29), n imaging lines (-0.18), icu (-0.17)
4A02X4Z	MEASUREMENT OF CARDIAC ELECTRICAL ACTIVITY, EXTERNAL APPROACH	-1.208	1814	organ system count (-0.32), work rvu (-0.25), n j code lines (+0.25)
HZ36ZZZ	INDIVIDUAL COUNSELING FOR SUBSTANCE ABUSE TREATMENT, PSYCHOEDUCATION	-1.239	1886	icu (-0.19), n imaging lines (-0.18), or (-0.15)
HZ33ZZZ	INDIVIDUAL COUNSELING FOR SUBSTANCE ABUSE TREATMENT, 12-STEP	-1.296	1615	organ system count (-0.20), icu (-0.19), n imaging lines (-0.18)
HZ39ZZZ	INDIVIDUAL COUNSELING FOR SUBSTANCE ABUSE TREATMENT, CONTINUING CARE	-1.383	3479	icu (-0.19), n imaging lines (-0.19), n distinct hcps (-0.15)

Tier 2 (n=9 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	5.833	5120	icu (+0.77), mechanical ventilation (+0.77), n imaging lines (+0.61)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	5.521	2629	mechanical ventilation (+0.86), icu (+0.82), organ system count (+0.63)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	4.915	1395	transfusion (+0.95), dialysis (+0.74), organ system count (+0.58)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	4.901	988	or (+0.88), n imaging lines (+0.84), n distinct rev codes (+0.61)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	3.823	2389	mechanical ventilation (+0.86), icu (+0.71), n imaging lines (+0.57)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.921	1520	or (+0.55), organ system count (+0.47), n distinct rev codes (+0.46)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	2.891	1547	organ system count (+0.56), work rvu (+0.47), icu (+0.43)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	2.874	1862	n imaging lines (+0.66), n distinct rev codes (+0.43), work rvu (+0.42)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.186	1413	n distinct rev codes (+0.49), or (+0.46), organ system count (+0.41)

Tier 3 (n=2 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	10.091	1148	relative claim charge (+1.43), multiple or days (+1.32), dialysis (+0.87)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	7.593	2213	dialysis (+1.33), multiple or days (+1.05), or (+1.02)

Key Driver Frequency

feature	count	pct
work rvu	19	41.300
icu	19	41.300
organ system count	18	39.100
n distinct rev codes	18	39.100
n j code lines	18	39.100
n imaging lines	16	34.800
relative claim charge	11	23.900
or	6	13.000
dialysis	4	8.700
multiple or days	3	6.500
mechanical ventilation	3	6.500
n distinct hcps	2	4.300
transfusion	1	2.200