IP - CA.1.ecmo_trach

CM Codes

Data Overview

11419 total codes in komodo_rii; 242 retained after n_claims > 500 filter.

CMS severity	n codes
MCC	86
No CC/MCC	79
CC	77

PCA Analysis

PC1 explains 26.0% of variance; PC1+PC2 together explain 48.2%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	n j code lines	organ system count	n imaging lines	relative claim charge	work rvu	transfusion
1	29.000	48645.000	28.869	29.151	2.250	7.087	1.952	0.804	3.611	0.486
2	85.000	237112.000	32.967	30.703	2.203	6.703	2.266	0.930	3.250	0.582
3	88.000	197814.000	35.179	31.804	2.329	6.487	2.388	1.058	3.551	0.692
4	40.000	56371.000	39.085	33.183	2.883	6.648	2.425	1.268	3.255	0.814

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	3	28	34	12	77
MCC	1	23	37	25	86
No CC/MCC	25	34	17	3	79
All	29	85	88	40	242

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.479	-0.005	0.541
rate_transfusion	0.462	-0.116	0.291
avg_n_distinct_rev_codes	0.458	-0.166	0.312
avg_length_of_stay	0.390	-0.048	0.404
rate_dialysis	0.336	0.072	0.283
avg_n_imaging_lines	0.202	-0.057	0.392
avg_n_j_code_lines	0.111	0.035	0.081
rate_icu	0.055	-0.126	0.044
rate_or	0.033	-0.252	-0.373
avg_work_rvu	0.001	0.181	-0.012
rate_multiple_or_days	-0.029	0.004	-0.353
rate_mechanical_ventilation	-0.067	0.028	0.122
avg_n_distinct_hcps	-0.086	-0.209	-0.487
avg_organ_system_count	-0.117	-0.049	-0.647

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D84821	Immunodeficiency due to drugs	No CC/MCC	3.613	4	838	n distinct rev codes (+0.97), dialysis (+0.76), length of stay (+0.62)
D6959	Other secondary thrombocytopenia	No CC/MCC	2.031	4	831	transfusion (+0.73), n distinct rev codes (+0.60), relative claim charge (+0.33)
D631	Anemia in chronic kidney disease	No CC/MCC	1.892	4	1725	dialysis (+1.06), transfusion (+0.48), n distinct rev codes (+0.45)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J9690	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	MCC	-2.299	1	1105	n distinct rev codes (-0.98), relative claim charge (-0.60), length of stay (-0.42)

Top Codes by Tier

Tier 1 (n=29 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I69351	Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side	CC	-2.077	592	relative claim charge (-0.51), transfusion (-0.46), n distinct rev codes (-0.46)
G40901	Epilepsy, unspecified, not intractable, with status epilepticus	No CC/MCC	-2.140	914	transfusion (-0.61), n distinct rev codes (-0.60), relative claim charge (-0.55)
E8342	Hypomagnesemia	No CC/MCC	-2.149	1550	relative claim charge (-0.51), transfusion (-0.37), length of stay (-0.35)
E860	Dehydration	No CC/MCC	-2.257	1046	relative claim charge (-0.51), n distinct rev codes (-0.48), transfusion (-0.39)
E876	Hypokalemia	No CC/MCC	-2.283	4051	relative claim charge (-0.50), transfusion (-0.45), n distinct rev codes (-0.44)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-2.291	1088	relative claim charge (-0.59), n distinct rev codes (-0.51), transfusion (-0.46)
J9690	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	MCC	-2.299	1105	n distinct rev codes (-0.98), relative claim charge (-0.60), length of stay (-0.42)
D649	Anemia, unspecified	No CC/MCC	-2.469	3503	relative claim charge (-0.57), n distinct rev codes (-0.54), transfusion (-0.48)
B9620	Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere	No CC/MCC	-2.515	517	n distinct rev codes (-0.73), transfusion (-0.65), dialysis (-0.32)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	-2.610	1468	n distinct rev codes (-0.74), relative claim charge (-0.53), length of stay (-0.49)

Tier 2 (n=85 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J1282	Pneumonia due to coronavirus disease 2019	No CC/MCC	-0.252	1292	n distinct rev codes (-0.50), relative claim charge (+0.29), organ system count (+0.16)
Q2112	Patent foramen ovale	No CC/MCC	-0.284	661	length of stay (-0.93), relative claim charge (+0.72), icu (-0.45)
E222	Syndrome of inappropriate secretion of antidiuretic hormone	CC	-0.295	725	dialysis (-0.36), length of stay (+0.34), transfusion (-0.33)
U071	COVID-19	MCC	-0.313	2082	n distinct rev codes (-0.50), relative claim charge (+0.20), length of stay (+0.20)
G8250	Quadriplegia, unspecified	MCC	-0.363	1619	transfusion (-0.36), dialysis (-0.30), n imaging lines (+0.29)
G911	Obstructive hydrocephalus	CC	-0.365	1449	transfusion (-0.58), dialysis (-0.43), n imaging lines (+0.29)
T797XXA	Traumatic subcutaneous emphysema, initial encounter	CC	-0.372	614	relative claim charge (-0.39), length of stay (-0.37), dialysis (-0.35)
E440	Moderate protein-calorie malnutrition	CC	-0.399	3201	relative claim charge (-0.13), transfusion (-0.11), dialysis (-0.11)
T17590A	Other foreign object in bronchus causing asphyxiation, initial encounter	CC	-0.407	596	dialysis (-0.19), transfusion (-0.12), relative claim charge (+0.09)
I428	Other cardiomyopathies	CC	-0.407	748	n imaging lines (-0.17), n j code lines (-0.13), dialysis (+0.12)

Tier 3 (n=88 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D849	Immunodeficiency, unspecified	CC	1.719	662	n distinct rev codes (+0.58), transfusion (+0.34), dialysis (+0.30)
L89153	Pressure ulcer of sacral region, stage 3	MCC	1.688	1421	length of stay (+0.97), relative claim charge (+0.76), n distinct rev codes (-0.19)
T8111XA	Postprocedural cardiogenic shock, initial encounter	MCC	1.608	802	transfusion (+1.11), length of stay (-0.83), dialysis (+0.68)
J1569	Pneumonia due to other Gram-negative bacteria	No CC/MCC	1.601	2599	relative claim charge (+0.53), length of stay (+0.35), n distinct hcps (+0.19)
J80	Acute respiratory distress syndrome	MCC	1.598	6675	relative claim charge (+0.56), transfusion (+0.43), dialysis (+0.28)
I5043	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure	MCC	1.595	1934	relative claim charge (+0.46), dialysis (+0.32), transfusion (+0.28)
A0472	Enterocolitis due to Clostridium difficile, not specified as recurrent	CC	1.576	1272	length of stay (+0.75), n distinct rev codes (+0.48), relative claim charge (+0.29)
A4159	Other Gram-negative sepsis	MCC	1.575	1428	relative claim charge (+0.67), length of stay (+0.42), transfusion (+0.29)
S270XXA	Traumatic pneumothorax, initial encounter	CC	1.467	1052	n distinct rev codes (+0.72), n imaging lines (+0.51), transfusion (+0.45)
J150	Pneumonia due to Klebsiella pneumoniae	MCC	1.370	3365	relative claim charge (+0.46), length of stay (+0.43), organ system count (+0.13)

Tier 4 (n=40 codes)

code	Description	CMS severity	Score	N claims	Key drivers
B377	Candidal sepsis	MCC	5.545	656	relative claim charge (+1.64), length of stay (+1.22), n distinct rev codes (+0.86)
A4181	Sepsis due to Enterococcus	MCC	5.012	732	relative claim charge (+1.68), length of stay (+1.14), n distinct rev codes (+0.76)
K651	Peritoneal abscess	MCC	4.812	1168	relative claim charge (+1.35), length of stay (+1.25), n distinct rev codes (+0.97)
K661	Hemoperitoneum	MCC	4.365	747	n distinct rev codes (+1.22), transfusion (+1.14), relative claim charge (+1.06)
N186	End stage renal disease	MCC	4.237	4095	dialysis (+1.77), relative claim charge (+0.82), transfusion (+0.65)
D65	Disseminated intravascular coagulation [defibrination syndrome]	MCC	4.187	1277	relative claim charge (+1.22), transfusion (+1.15), dialysis (+0.83)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.946	1543	dialysis (+1.79), transfusion (+0.69), relative claim charge (+0.65)
I330	Acute and subacute infective endocarditis	MCC	3.931	1059	relative claim charge (+0.90), n distinct rev codes (+0.86), transfusion (+0.83)
J942	Hemothorax	CC	3.840	623	transfusion (+1.04), n distinct rev codes (+0.93), relative claim charge (+0.74)
T794XXA	Traumatic shock, initial encounter	MCC	3.706	1482	n distinct rev codes (+1.14), transfusion (+1.03), relative claim charge (+0.75)

Key Driver Frequency

feature	count	pct
relative claim charge	161	66.500
transfusion	153	63.200
n distinct rev codes	143	59.100
length of stay	107	44.200
dialysis	76	31.400
n imaging lines	44	18.200
organ system count	16	6.600
n j code lines	12	5.000
n distinct hcps	11	4.500
mechanical ventilation	2	0.800
icu	1	0.400

PCS Codes

Data Overview

10396 total codes in komodo_rii; 124 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 31.6% of variance; PC1+PC2 together explain 52.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	work rvu	n j code lines	n imaging lines	organ system count	n distinct rev codes	mechanical ventilation	transfusion
1	58.000	225593.000	35.036	2.687	2.494	2.506	6.293	31.842	0.915	0.622
2	44.000	92660.000	35.904	3.929	3.317	2.279	6.405	32.239	0.871	0.744
3	22.000	24778.000	28.760	4.013	3.731	1.703	5.675	32.267	0.556	0.880

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
rate_transfusion	0.355	-0.155
avg_relative_claim_charge	0.303	-0.257
rate_dialysis	0.300	-0.070
avg_n_j_code_lines	0.174	0.023
rate_multiple_or_days	0.160	-0.171
avg_work_rvu	0.121	0.087
rate_or	0.100	-0.187
avg_n_distinct_rev_codes	0.069	-0.288
avg_organ_system_count	-0.190	-0.003
avg_length_of_stay	-0.193	-0.110
avg_n_distinct_hcps	-0.275	-0.033
avg_n_imaging_lines	-0.357	0.075
rate_icu	-0.384	-0.077
rate_mechanical_ventilation	-0.429	0.128

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=58 codes)

code	Description	Score	N claims	Key drivers
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	-0.743	656	length of stay (-0.31), transfusion (+0.27), icu (-0.27)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	-0.752	897	n distinct hcps (-0.34), relative claim charge (+0.28), transfusion (+0.27)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.781	3062	relative claim charge (-0.36), icu (-0.23), mechanical ventilation (-0.22)
0DH68UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-0.874	1193	transfusion (-0.40), mechanical ventilation (-0.23), relative claim charge (-0.21)
0B113F4	BYPASS TRACHEA TO CUTANEOUS WITH TRACHEOSTOMY DEVICE, PERCUTANEOUS APPROACH	-0.934	22238	n distinct hcps (+0.39), transfusion (-0.26), or (-0.25)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	-0.949	1126	n distinct hcps (+0.26), mechanical ventilation (-0.24), relative claim charge (-0.20)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	-0.956	8596	icu (-0.21), mechanical ventilation (-0.18), relative claim charge (-0.18)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	-0.990	15881	mechanical ventilation (-0.21), icu (-0.15), transfusion (-0.11)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	-1.028	3170	n distinct hcps (-0.58), relative claim charge (-0.19), organ system count (-0.14)
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	-1.063	45448	mechanical ventilation (-0.49), n distinct hcps (+0.24), transfusion (-0.23)

Tier 2 (n=44 codes)

code	Description	Score	N claims	Key drivers
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	1.725	566	transfusion (+0.37), multiple or days (+0.31), or (+0.18)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	1.477	779	icu (+0.98), transfusion (+0.31), relative claim charge (+0.27)
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	1.419	2388	dialysis (+1.12), transfusion (+0.56), n distinct hcps (-0.25)
0D1B0Z4	BYPASS ILEUM TO CUTANEOUS, OPEN APPROACH	1.176	645	relative claim charge (+0.90), n distinct hcps (+0.50), transfusion (+0.37)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	1.174	1451	icu (+0.42), mechanical ventilation (+0.33), n imaging lines (+0.29)
0W3P8ZZ	CONTROL BLEEDING IN GASTROINTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.102	647	transfusion (+0.54), relative claim charge (+0.52), length of stay (-0.35)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	0.988	1027	icu (+0.40), mechanical ventilation (+0.35), n imaging lines (+0.31)
0B9H8ZX	DRAINAGE OF LUNG LINGULA, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.970	644	work rvu (+1.07), n j code lines (+0.50), icu (-0.41)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	0.876	1711	dialysis (+1.07), transfusion (+0.41), organ system count (-0.39)
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	0.809	1226	mechanical ventilation (+0.23), transfusion (+0.23), icu (+0.20)

Tier 3 (n=22 codes)

code	Description	Score	N claims	Key drivers
5A1522F	EXTRACORPOREAL OXYGENATION, MEMBRANE, CENTRAL	5.795	872	mechanical ventilation (+1.76), icu (+0.92), n imaging lines (+0.71)
0BYM0Z0	TRANSPLANTATION OF BILATERAL LUNGS, ALLOGENEIC, OPEN APPROACH	5.684	539	mechanical ventilation (+1.34), relative claim charge (+1.26), dialysis (+1.23)
02HA3RZ	INSERTION OF SHORT-TERM EXTERNAL HEART ASSIST SYSTEM INTO HEART, PERCUTANEOUS APPROACH	4.961	1054	mechanical ventilation (+1.22), icu (+0.77), n imaging lines (+0.63)
5A1522G	EXTRACORPOREAL OXYGENATION, MEMBRANE, PERIPHERAL VENO-ARTERIAL	4.950	4846	mechanical ventilation (+1.30), icu (+0.93), length of stay (+0.64)
02PA3RZ	REMOVAL OF SHORT-TERM EXTERNAL HEART ASSIST SYSTEM FROM HEART, PERCUTANEOUS APPROACH	4.877	572	mechanical ventilation (+0.99), transfusion (+0.58), n j code lines (+0.52)
5A0221D	ASSISTANCE WITH CARDIAC OUTPUT USING IMPELLER PUMP, CONTINUOUS	4.718	1065	mechanical ventilation (+1.16), icu (+0.76), n imaging lines (+0.61)
021009W	BYPASS CORONARY ARTERY, ONE ARTERY FROM AORTA WITH AUTOLOGOUS VENOUS TISSUE, OPEN APPROACH	4.486	630	mechanical ventilation (+0.80), icu (+0.61), transfusion (+0.59)
06BQ4ZZ	EXCISION OF LEFT SAPHENOUS VEIN, PERCUTANEOUS ENDOSCOPIC APPROACH	4.456	923	icu (+0.95), mechanical ventilation (+0.63), n distinct hcps (+0.59)
02100Z9	BYPASS CORONARY ARTERY, ONE ARTERY FROM LEFT INTERNAL MAMMARY, OPEN APPROACH	4.278	1291	icu (+0.84), n distinct hcps (+0.72), mechanical ventilation (+0.62)
021109W	BYPASS CORONARY ARTERY, TWO ARTERIES FROM AORTA WITH AUTOLOGOUS VENOUS TISSUE, OPEN APPROACH	4.254	677	icu (+1.07), n distinct hcps (+0.67), mechanical ventilation (+0.66)

Key Driver Frequency

feature	count	pct
icu	63	50.800
mechanical ventilation	61	49.200
transfusion	61	49.200
relative claim charge	40	32.300
n distinct hcps	37	29.800
n imaging lines	34	27.400
organ system count	18	14.500
dialysis	18	14.500
n j code lines	17	13.700
length of stay	10	8.100
multiple or days	9	7.300
or	3	2.400
work rvu	1	0.800