IP - CA.1.heart_transplant

CM Codes

Data Overview

3151 total codes in komodo_rii; 37 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	15
MCC	12
CC	10

PCA Analysis

PC1 explains 29.4% of variance; PC1+PC2 together explain 51.8%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	work rvu	n distinct rev codes	n j code lines	organ system count	n imaging lines	relative claim charge	n distinct hcps
1	7.000	5435.000	31.393	5.111	33.034	5.541	6.154	1.258	0.880	0.939
2	16.000	19021.000	34.153	5.629	33.812	5.436	5.924	1.322	0.942	0.870
3	12.000	16204.000	34.668	5.285	34.182	5.009	5.345	1.488	1.049	0.818
4	2.000	1399.000	42.739	7.354	35.372	6.485	5.565	1.801	1.283	0.783

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	2	7	1	0	10
MCC	0	1	9	2	12
No CC/MCC	5	8	2	0	15
All	7	16	12	2	37

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.463	-0.002	0.691
avg_n_imaging_lines	0.431	0.093	0.644
avg_n_distinct_rev_codes	0.324	-0.052	0.294
avg_length_of_stay	0.305	0.029	0.094
rate_transfusion	0.240	-0.269	0.481
rate_dialysis	0.104	-0.229	0.077
avg_work_rvu	0.087	-0.172	-0.248
avg_n_j_code_lines	0.015	-0.312	-0.270
rate_mechanical_ventilation	-0.110	-0.001	-0.150
rate_multiple_or_days	-0.116	-0.279	-0.420
rate_icu	-0.155	-0.053	-0.089
avg_organ_system_count	-0.283	-0.069	-0.533
avg_n_distinct_hcps	-0.286	-0.063	-0.604
rate_or	-0.338	-0.217	-0.506

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (0 codes)

None.

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

None.

Top Codes by Tier

Tier 1 (n=7 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I420	Dilated cardiomyopathy	CC	-1.758	948	transfusion (-0.58), n distinct hcps (-0.53), relative claim charge (-0.39)
I480	Paroxysmal atrial fibrillation	No CC/MCC	-1.822	504	relative claim charge (-0.47), organ system count (-0.42), n distinct hcps (-0.34)
J9811	Atelectasis	CC	-1.889	658	organ system count (-0.57), n distinct hcps (-0.39), icu (-0.31)
I255	Ischemic cardiomyopathy	No CC/MCC	-2.306	862	n imaging lines (-0.72), n distinct rev codes (-0.58), length of stay (-0.40)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	-2.787	649	relative claim charge (-0.60), organ system count (-0.43), n imaging lines (-0.38)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	-2.870	1076	n distinct rev codes (-0.86), length of stay (-0.62), n imaging lines (-0.57)
E785	Hyperlipidemia, unspecified	No CC/MCC	-4.059	738	relative claim charge (-0.78), n distinct hcps (-0.50), length of stay (-0.45)

Tier 2 (n=16 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D689	Coagulation defect, unspecified	CC	-0.058	1109	transfusion (+0.56), n imaging lines (-0.34), or (-0.23)
D84821	Immunodeficiency due to drugs	No CC/MCC	-0.097	762	dialysis (+0.47), n imaging lines (-0.44), n distinct hcps (-0.42)
E871	Hypo-osmolality and hyponatremia	CC	-0.108	1624	n distinct rev codes (+0.28), n imaging lines (+0.19), length of stay (+0.18)
T8111XA	Postprocedural cardiogenic shock, initial encounter	MCC	-0.164	548	n distinct hcps (+0.46), n imaging lines (-0.42), n distinct rev codes (-0.38)
I428	Other cardiomyopathies	CC	-0.172	1045	relative claim charge (-0.40), or (-0.32), icu (+0.18)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	-0.428	1614	transfusion (-0.19), n distinct hcps (-0.19), length of stay (+0.17)
I4892	Unspecified atrial flutter	CC	-0.443	511	or (-0.37), organ system count (-0.32), n distinct rev codes (+0.28)
D696	Thrombocytopenia, unspecified	No CC/MCC	-0.502	1327	or (-0.25), relative claim charge (-0.19), icu (+0.15)
I5022	Chronic systolic (congestive) heart failure	CC	-0.738	525	n imaging lines (-0.70), n distinct hcps (+0.49), n distinct rev codes (-0.45)
E8720	Acidosis, unspecified	No CC/MCC	-0.864	1170	length of stay (-0.26), n imaging lines (-0.22), organ system count (-0.22)

Tier 3 (n=12 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N170	Acute kidney failure with tubular necrosis	MCC	3.075	1601	relative claim charge (+0.95), n imaging lines (+0.51), or (+0.50)
J189	Pneumonia, unspecified organism	MCC	2.616	620	n imaging lines (+0.57), or (+0.55), relative claim charge (+0.43)
I509	Heart failure, unspecified	No CC/MCC	2.046	536	n distinct rev codes (+0.49), length of stay (+0.44), organ system count (+0.37)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	1.732	2802	organ system count (+0.47), n distinct hcps (+0.29), icu (+0.25)
I4901	Ventricular fibrillation	MCC	1.584	643	relative claim charge (+0.57), organ system count (+0.45), or (+0.29)
J9601	Acute respiratory failure with hypoxia	MCC	1.289	2506	or (+0.47), relative claim charge (+0.31), n imaging lines (+0.29)
I5043	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure	MCC	1.183	2170	organ system count (+0.42), or (+0.42), transfusion (-0.38)
K7200	Acute and subacute hepatic failure without coma	MCC	1.114	1021	n imaging lines (+0.67), relative claim charge (+0.44), mechanical ventilation (-0.19)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	0.878	764	length of stay (-0.64), n distinct rev codes (-0.61), organ system count (+0.52)
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	0.824	2444	organ system count (+0.32), n distinct hcps (+0.26), or (+0.25)

Tier 4 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E43	Unspecified severe protein-calorie malnutrition	MCC	6.362	722	relative claim charge (+1.43), n imaging lines (+1.35), length of stay (+0.92)
A419	Sepsis, unspecified organism	MCC	4.506	677	relative claim charge (+1.22), n imaging lines (+0.97), or (+0.94)

Key Driver Frequency

feature	count	pct
relative claim charge	17	45.900
n imaging lines	17	45.900
or	16	43.200
organ system count	15	40.500
n distinct hcps	12	32.400
length of stay	11	29.700
n distinct rev codes	10	27.000
transfusion	7	18.900
icu	4	10.800
dialysis	1	2.700
mechanical ventilation	1	2.700

PCS Codes

Data Overview

2416 total codes in komodo_rii; 23 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 44.9% of variance; PC1+PC2 together explain 60.0%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n j code lines	n distinct rev codes	work rvu	organ system count	dialysis	n imaging lines	n distinct hcps
1	4.000	3440.000	39.667	10.830	35.830	7.457	5.931	0.633	1.598	1.005
2	5.000	6761.000	34.797	5.745	34.693	4.624	5.675	0.429	1.448	0.980
3	5.000	4743.000	39.699	5.976	34.913	4.151	5.410	0.696	1.395	0.927
4	7.000	14804.000	34.088	4.813	33.760	4.918	5.186	0.391	1.504	0.841
5	2.000	1840.000	24.002	3.403	31.549	3.096	4.993	0.219	1.280	0.740

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.123	0.170
rate_transfusion	0.005	-0.442
avg_n_imaging_lines	-0.103	-0.042
rate_dialysis	-0.170	-0.125
avg_length_of_stay	-0.258	-0.211
rate_mechanical_ventilation	-0.261	-0.263
avg_work_rvu	-0.274	0.341
rate_or	-0.275	-0.385
rate_icu	-0.290	-0.422
avg_n_distinct_rev_codes	-0.323	-0.223
avg_n_j_code_lines	-0.334	0.033
avg_n_distinct_hcps	-0.335	-0.491
rate_multiple_or_days	-0.341	0.073
avg_organ_system_count	-0.361	-0.455

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=4 codes)

code	Description	Score	N claims	Key drivers
5A1522G	EXTRACORPOREAL OXYGENATION, MEMBRANE, PERIPHERAL VENO-ARTERIAL	-3.164	534	n distinct rev codes (-0.55), mechanical ventilation (-0.52), n j code lines (-0.41)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	-3.990	1280	organ system count (-0.61), multiple or days (-0.52), n j code lines (-0.43)
02BK3ZX	EXCISION OF RIGHT VENTRICLE, PERCUTANEOUS APPROACH, DIAGNOSTIC	-4.297	874	n j code lines (-0.83), multiple or days (-0.72), work rvu (-0.53)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	-5.105	752	multiple or days (-0.98), n j code lines (-0.77), organ system count (-0.71)

Tier 2 (n=5 codes)

code	Description	Score	N claims	Key drivers
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.940	540	mechanical ventilation (-0.63), n distinct hcps (-0.49), icu (-0.43)
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	-0.966	814	or (-0.33), organ system count (-0.32), n distinct hcps (-0.27)
02HQ32Z	INSERTION OF MONITORING DEVICE INTO RIGHT PULMONARY ARTERY, PERCUTANEOUS APPROACH	-1.118	535	work rvu (+0.49), or (-0.49), icu (-0.42)
5A1221Z	PERFORMANCE OF CARDIAC OUTPUT, CONTINUOUS	-1.345	2644	or (-0.37), icu (-0.32), n distinct hcps (-0.22)
4A023N6	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, RIGHT HEART, PERCUTANEOUS APPROACH	-1.968	2228	n distinct rev codes (-0.30), or (-0.28), work rvu (-0.28)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
02PA0RZ	REMOVAL OF SHORT-TERM EXTERNAL HEART ASSIST SYSTEM FROM HEART, OPEN APPROACH	0.678	653	n distinct hcps (-0.25), or (+0.24), work rvu (+0.22)
02PA0QZ	REMOVAL OF IMPLANTABLE HEART ASSIST SYSTEM FROM HEART, OPEN APPROACH	0.548	593	work rvu (+0.29), organ system count (-0.23), n j code lines (+0.21)
02PA0MZ	REMOVAL OF CARDIAC LEAD FROM HEART, OPEN APPROACH	0.207	641	mechanical ventilation (+0.31), length of stay (-0.30), dialysis (-0.30)
5A02210	ASSISTANCE WITH CARDIAC OUTPUT USING BALLOON PUMP, CONTINUOUS	0.012	1485	organ system count (+0.27), or (+0.26), n distinct rev codes (-0.24)
0JPT0PZ	REMOVAL OF CARDIAC RHYTHM RELATED DEVICE FROM TRUNK SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.385	1371	mechanical ventilation (+0.32), dialysis (-0.29), length of stay (-0.26)

Tier 4 (n=7 codes)

code	Description	Score	N claims	Key drivers
02HA0QZ	INSERTION OF IMPLANTABLE HEART ASSIST SYSTEM INTO HEART, OPEN APPROACH	2.212	2399	n distinct hcps (+0.57), organ system count (+0.39), icu (+0.36)
X2HL0F9	None	2.194	1420	organ system count (+0.43), icu (+0.33), n distinct rev codes (+0.29)
5A0221D	ASSISTANCE WITH CARDIAC OUTPUT USING IMPELLER PUMP, CONTINUOUS	2.116	2781	n distinct rev codes (+0.38), icu (+0.36), or (+0.25)
02HA3RZ	INSERTION OF SHORT-TERM EXTERNAL HEART ASSIST SYSTEM INTO HEART, PERCUTANEOUS APPROACH	1.914	2041	icu (+0.51), organ system count (+0.27), or (+0.24)
02PA3RZ	REMOVAL OF SHORT-TERM EXTERNAL HEART ASSIST SYSTEM FROM HEART, PERCUTANEOUS APPROACH	1.769	1539	n j code lines (+0.29), n distinct rev codes (+0.26), length of stay (+0.24)
02YA0Z0	TRANSPLANTATION OF HEART, ALLOGENEIC, OPEN APPROACH	1.485	2573	organ system count (+0.49), or (+0.44), n distinct hcps (+0.35)
5A02216	ASSISTANCE WITH CARDIAC OUTPUT USING OTHER PUMP, CONTINUOUS	1.234	2051	n distinct hcps (+0.34), multiple or days (+0.31), n j code lines (+0.26)

Tier 5 (n=2 codes)

code	Description	Score	N claims	Key drivers
02100Z9	BYPASS CORONARY ARTERY, ONE ARTERY FROM LEFT INTERNAL MAMMARY, OPEN APPROACH	4.661	645	n distinct rev codes (+0.68), length of stay (+0.62), n distinct hcps (+0.59)
02HA0RZ	INSERTION OF SHORT-TERM EXTERNAL HEART ASSIST SYSTEM INTO HEART, OPEN APPROACH	4.248	1195	n distinct rev codes (+0.74), n distinct hcps (+0.67), length of stay (+0.54)

Key Driver Frequency

feature	count	pct
or	9	39.100
organ system count	9	39.100
n distinct hcps	9	39.100
n distinct rev codes	8	34.800
icu	7	30.400
n j code lines	7	30.400
work rvu	5	21.700
length of stay	5	21.700
mechanical ventilation	4	17.400
multiple or days	4	17.400
dialysis	2	8.700