IP - CA.1.endo_cardiac_valve

CM Codes

Data Overview

6053 total codes in komodo_rii; 161 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	113
CC	35
MCC	13

PCA Analysis

PC1 explains 58.3% of variance; PC1+PC2 together explain 67.6%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	work rvu	n imaging lines	relative claim charge	organ system count	n j code lines	transfusion
1	125.000	565596.000	3.353	16.242	0.937	0.209	1.011	4.214	0.326	0.093
2	25.000	56935.000	6.218	19.164	1.101	0.471	1.214	4.679	0.452	0.187
3	11.000	11969.000	11.753	23.928	1.768	1.013	1.646	4.790	0.817	0.305

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	23	10	2	35
MCC	2	3	8	13
No CC/MCC	100	12	1	113
All	125	25	11	161

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.343	-0.249	0.531
avg_length_of_stay	0.341	-0.247	0.530
avg_relative_claim_charge	0.338	-0.241	0.508
avg_n_imaging_lines	0.332	-0.293	0.483
rate_transfusion	0.327	-0.169	0.400
rate_mechanical_ventilation	0.317	-0.215	0.474
rate_icu	0.298	-0.101	0.525
avg_n_j_code_lines	0.285	-0.147	0.370
rate_multiple_or_days	0.233	-0.104	0.284
rate_or	0.200	-0.066	0.322
avg_work_rvu	0.173	-0.090	0.270
rate_dialysis	0.145	-0.056	0.454
avg_organ_system_count	0.124	-0.216	-0.076
avg_n_distinct_hcps	0.067	-0.367	-0.093

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (1 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E8720	Acidosis, unspecified	No CC/MCC	6.051	3	1338	transfusion (+0.79), n distinct rev codes (+0.71), mechanical ventilation (+0.64)

Under-tiered: Tier 1, MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I5033	Acute on chronic diastolic (congestive) heart failure	MCC	-0.446	1	15299	n distinct hcps (-0.13), organ system count (-0.11), work rvu (-0.11)
I5031	Acute diastolic (congestive) heart failure	MCC	0.339	1	778	n imaging lines (+0.30), work rvu (+0.21), n j code lines (-0.18)

Top Codes by Tier

Tier 1 (n=125 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D696	Thrombocytopenia, unspecified	No CC/MCC	0.440	5312	transfusion (+0.20), multiple or days (-0.19), work rvu (-0.10)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	0.433	2258	length of stay (+0.20), or (-0.18), relative claim charge (+0.18)
I5031	Acute diastolic (congestive) heart failure	MCC	0.339	778	n imaging lines (+0.30), work rvu (+0.21), n j code lines (-0.18)
I471	None	CC	0.232	632	n distinct hcps (+0.20), multiple or days (-0.14), length of stay (+0.13)
E8351	Hypocalcemia	No CC/MCC	0.206	565	icu (-0.36), multiple or days (+0.23), transfusion (+0.17)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	0.130	533	organ system count (+0.20), n j code lines (+0.18), transfusion (+0.14)
I25810	Atherosclerosis of coronary artery bypass graft(s) without angina pectoris	CC	0.111	822	multiple or days (+0.31), n j code lines (+0.21), organ system count (-0.12)
I509	Heart failure, unspecified	No CC/MCC	0.087	3260	work rvu (+0.53), icu (-0.21), n j code lines (+0.19)
T82857A	Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter	CC	0.075	3912	multiple or days (-0.20), work rvu (-0.12), or (+0.12)
I441	Atrioventricular block, second degree	No CC/MCC	-0.054	866	multiple or days (+0.40), transfusion (-0.11), organ system count (-0.11)

Tier 2 (n=25 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F05	Delirium due to known physiological condition	CC	5.052	585	n imaging lines (+0.86), length of stay (+0.71), n distinct rev codes (+0.70)
E875	Hyperkalemia	No CC/MCC	3.984	800	transfusion (+0.50), n distinct rev codes (+0.49), multiple or days (+0.44)
N179	Acute kidney failure, unspecified	CC	3.826	5215	length of stay (+0.61), n distinct rev codes (+0.57), n imaging lines (+0.55)
D62	Acute posthemorrhagic anemia	CC	3.567	4261	transfusion (+1.30), icu (+0.44), relative claim charge (+0.34)
J9811	Atelectasis	CC	3.514	1042	icu (+0.76), n distinct rev codes (+0.51), transfusion (+0.45)
N186	End stage renal disease	MCC	3.505	2651	dialysis (+1.10), n j code lines (+0.46), transfusion (+0.41)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.263	2199	dialysis (+1.04), transfusion (+0.37), n j code lines (+0.34)
K5900	Constipation, unspecified	No CC/MCC	3.175	604	n distinct rev codes (+0.50), length of stay (+0.46), n imaging lines (+0.45)
E871	Hypo-osmolality and hyponatremia	CC	2.859	3399	length of stay (+0.54), n distinct rev codes (+0.48), n imaging lines (+0.46)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	2.770	1705	transfusion (+0.50), icu (+0.39), n j code lines (+0.36)

Tier 3 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G9341	Metabolic encephalopathy	MCC	13.197	528	mechanical ventilation (+2.35), n imaging lines (+1.69), n distinct rev codes (+1.44)
N170	Acute kidney failure with tubular necrosis	MCC	13.119	731	relative claim charge (+1.62), transfusion (+1.58), length of stay (+1.57)
E43	Unspecified severe protein-calorie malnutrition	MCC	10.396	760	n j code lines (+2.10), relative claim charge (+1.22), multiple or days (+1.15)
J9601	Acute respiratory failure with hypoxia	MCC	9.162	3467	mechanical ventilation (+1.45), n distinct rev codes (+1.01), relative claim charge (+0.95)
J189	Pneumonia, unspecified organism	MCC	8.999	848	length of stay (+1.25), n distinct rev codes (+1.20), n imaging lines (+1.17)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	8.879	994	length of stay (+1.18), n distinct rev codes (+1.12), relative claim charge (+1.04)
I21A1	Myocardial infarction type 2	MCC	6.634	908	n imaging lines (+1.21), relative claim charge (+1.04), n distinct rev codes (+0.99)
J90	Pleural effusion, not elsewhere classified	CC	6.268	740	work rvu (+0.88), transfusion (+0.73), n j code lines (+0.71)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	6.236	1000	n imaging lines (+1.21), relative claim charge (+1.13), length of stay (+0.92)
E8720	Acidosis, unspecified	No CC/MCC	6.051	1338	transfusion (+0.79), n distinct rev codes (+0.71), mechanical ventilation (+0.64)

Key Driver Frequency

feature	count	pct
icu	63	39.100
n distinct rev codes	62	38.500
transfusion	57	35.400
length of stay	53	32.900
multiple or days	46	28.600
relative claim charge	41	25.500
n j code lines	35	21.700
n imaging lines	32	19.900
or	31	19.300
work rvu	23	14.300
organ system count	22	13.700
mechanical ventilation	12	7.500
dialysis	4	2.500
n distinct hcps	2	1.200

PCS Codes

Data Overview

2494 total codes in komodo_rii; 47 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 53.4% of variance; PC1+PC2 together explain 65.1%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	work rvu	relative claim charge	n imaging lines	n j code lines	mechanical ventilation
1	22.000	163478.000	3.338	16.646	3.678	0.933	1.011	0.220	0.416	0.009
2	11.000	23365.000	4.917	18.550	3.811	0.902	1.199	0.320	0.547	0.024
3	10.000	19066.000	7.530	20.896	4.278	1.218	1.361	0.621	0.586	0.039
4	4.000	3212.000	11.663	24.411	4.715	1.663	1.745	0.868	1.036	0.287

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.351	-0.431
avg_length_of_stay	0.349	-0.317
avg_relative_claim_charge	0.345	-0.319
avg_n_imaging_lines	0.328	-0.320
avg_organ_system_count	0.320	-0.256
rate_icu	0.290	-0.458
rate_transfusion	0.262	-0.295
rate_mechanical_ventilation	0.243	-0.294
rate_multiple_or_days	0.223	-0.306
avg_n_j_code_lines	0.216	-0.570
avg_n_distinct_hcps	0.187	0.050
rate_or	0.186	-0.179
avg_work_rvu	0.182	-0.433
rate_dialysis	0.124	-0.398

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=22 codes)

code	Description	Score	N claims	Key drivers
027F3ZZ	DILATION OF AORTIC VALVE, PERCUTANEOUS APPROACH	-1.432	2242	organ system count (-0.22), n distinct rev codes (-0.19), length of stay (-0.19)
B41F1ZZ	FLUOROSCOPY OF RIGHT LOWER EXTREMITY ARTERIES USING LOW OSMOLAR CONTRAST	-1.620	2951	length of stay (-0.31), relative claim charge (-0.26), n distinct rev codes (-0.25)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	-1.643	9818	relative claim charge (-0.21), length of stay (-0.19), n distinct rev codes (-0.18)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-1.674	1374	work rvu (+0.43), organ system count (-0.39), relative claim charge (-0.33)
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	-1.679	11389	relative claim charge (-0.24), n imaging lines (-0.21), length of stay (-0.21)
5A1223Z	PERFORMANCE OF CARDIAC PACING, CONTINUOUS	-1.737	13556	work rvu (-0.28), length of stay (-0.24), n distinct rev codes (-0.24)
X2A5312	CEREBRAL EMBOLIC FILTRATION, DUAL FILTER IN INNOMINATE ARTERY AND LEFT COMMON CAROTID ARTERY, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 2	-1.820	6911	n distinct hcps (+0.47), work rvu (-0.30), n distinct rev codes (-0.29)
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	-1.820	3729	organ system count (-0.25), n distinct rev codes (-0.23), multiple or days (-0.21)
B24CZZ4	ULTRASONOGRAPHY OF PERICARDIUM, TRANSESOPHAGEAL	-1.898	504	relative claim charge (-0.31), length of stay (-0.30), multiple or days (-0.30)
02UJ3JZ	SUPPLEMENT TRICUSPID VALVE WITH SYNTHETIC SUBSTITUTE, PERCUTANEOUS APPROACH	-1.942	1161	icu (-0.40), organ system count (-0.33), n distinct rev codes (-0.33)

Tier 2 (n=11 codes)

code	Description	Score	N claims	Key drivers
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	0.441	1133	length of stay (+0.16), relative claim charge (+0.13), icu (+0.11)
02RG38Z	REPLACEMENT OF MITRAL VALVE WITH ZOOPLASTIC TISSUE, PERCUTANEOUS APPROACH	0.084	1324	organ system count (+0.37), multiple or days (-0.24), relative claim charge (+0.12)
4A133J1	MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH	0.038	707	n j code lines (+0.55), n distinct hcps (-0.33), icu (+0.23)
02H63JZ	INSERTION OF PACEMAKER LEAD INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	-0.135	3575	relative claim charge (+0.22), n j code lines (-0.15), organ system count (-0.15)
0JH606Z	INSERTION OF PACEMAKER, DUAL CHAMBER INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.176	3437	relative claim charge (+0.22), n j code lines (-0.15), n imaging lines (-0.15)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	-0.402	3082	icu (+0.19), organ system count (-0.15), n distinct hcps (-0.09)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	-0.474	882	icu (+0.32), multiple or days (+0.32), length of stay (-0.29)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	-0.479	1119	icu (+0.33), n j code lines (+0.28), organ system count (-0.23)
02PA3MZ	REMOVAL OF CARDIAC LEAD FROM HEART, PERCUTANEOUS APPROACH	-0.492	1041	icu (+0.50), or (+0.42), organ system count (-0.35)
02HK3JZ	INSERTION OF PACEMAKER LEAD INTO RIGHT VENTRICLE, PERCUTANEOUS APPROACH	-0.510	5433	work rvu (-0.19), organ system count (-0.18), n j code lines (-0.17)

Tier 3 (n=10 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.711	1866	transfusion (+1.41), organ system count (+0.58), n distinct rev codes (+0.41)
02HK3NZ	INSERTION OF INTRACARDIAC PACEMAKER INTO RIGHT VENTRICLE, PERCUTANEOUS APPROACH	2.790	609	multiple or days (+0.73), relative claim charge (+0.59), n distinct rev codes (+0.36)
4A023N6	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, RIGHT HEART, PERCUTANEOUS APPROACH	2.536	2381	length of stay (+0.52), n imaging lines (+0.49), work rvu (+0.36)
B211YZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING OTHER CONTRAST	2.256	852	n imaging lines (+0.47), n distinct rev codes (+0.33), n j code lines (+0.29)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	2.154	1833	dialysis (+0.81), organ system count (+0.63), n distinct rev codes (+0.25)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.744	1629	organ system count (+0.60), length of stay (+0.29), n distinct rev codes (+0.28)
027034Z	DILATION OF CORONARY ARTERY, ONE ARTERY WITH DRUG-ELUTING INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	1.620	851	n imaging lines (+0.47), n distinct rev codes (+0.39), relative claim charge (+0.35)
4A023N8	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, BILATERAL, PERCUTANEOUS APPROACH	1.437	2309	n imaging lines (+0.60), length of stay (+0.40), n distinct rev codes (+0.31)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.379	1429	icu (+0.36), or (+0.23), organ system count (+0.22)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	1.160	5307	n imaging lines (+0.56), length of stay (+0.31), n distinct rev codes (+0.27)

Tier 4 (n=4 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	9.418	608	mechanical ventilation (+1.60), relative claim charge (+1.26), n distinct rev codes (+1.03)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	6.697	615	n j code lines (+0.86), multiple or days (+0.79), icu (+0.67)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	6.117	514	length of stay (+1.03), n distinct rev codes (+1.01), n imaging lines (+0.78)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	5.572	1475	length of stay (+0.77), relative claim charge (+0.75), n imaging lines (+0.62)

Key Driver Frequency

feature	count	pct
n distinct rev codes	24	51.100
length of stay	22	46.800
relative claim charge	20	42.600
organ system count	16	34.000
icu	14	29.800
n imaging lines	11	23.400
n j code lines	9	19.100
multiple or days	7	14.900
work rvu	6	12.800
n distinct hcps	5	10.600
or	4	8.500
dialysis	1	2.100
transfusion	1	2.100
mechanical ventilation	1	2.100