IP - CA.1.major_cardiac_catheterization

CM Codes

Data Overview

7008 total codes in komodo_rii; 227 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	135
CC	60
MCC	32

PCA Analysis

PC1 explains 45.7% of variance; PC1+PC2 together explain 58.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	n j code lines	n imaging lines	work rvu	relative claim charge	organ system count	transfusion
1	138.000	468275.000	8.152	22.470	1.029	0.371	1.881	0.975	5.093	0.548
2	63.000	153875.000	10.458	24.580	1.279	0.600	2.123	1.153	5.233	0.663
3	26.000	40511.000	15.107	27.902	1.940	1.182	2.628	1.558	5.470	0.796

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	26	25	9	60
MCC	3	15	14	32
No CC/MCC	109	23	3	135
All	138	63	26	227

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.375	-0.150	0.542
avg_n_distinct_rev_codes	0.374	-0.087	0.570
avg_length_of_stay	0.370	-0.125	0.525
avg_n_imaging_lines	0.359	-0.149	0.478
rate_mechanical_ventilation	0.337	-0.161	0.417
rate_transfusion	0.302	-0.111	0.546
rate_multiple_or_days	0.279	-0.037	0.214
avg_n_j_code_lines	0.271	-0.044	0.281
rate_dialysis	0.222	-0.115	0.472
rate_icu	0.160	0.030	0.290
avg_organ_system_count	0.102	-0.160	-0.139
avg_work_rvu	0.102	0.024	0.041
rate_or	0.042	-0.072	0.062
avg_n_distinct_hcps	-0.003	-0.092	-0.137

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
G928	Other toxic encephalopathy	No CC/MCC	8.670	3	871	n j code lines (+1.31), n imaging lines (+1.24), length of stay (+1.07)
I71010	Dissection of ascending aorta	No CC/MCC	4.548	3	3237	n imaging lines (+0.86), n distinct rev codes (+0.75), transfusion (+0.73)
I71011	Dissection of aortic arch	No CC/MCC	4.529	3	908	n imaging lines (+0.91), n distinct rev codes (+0.62), relative claim charge (+0.54)

Under-tiered: Tier 1, MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I511	Rupture of chordae tendineae, not elsewhere classified	MCC	-3.367	1	3745	transfusion (-0.61), relative claim charge (-0.59), length of stay (-0.51)
Q213	Tetralogy of Fallot	MCC	-2.529	1	685	transfusion (+0.79), length of stay (-0.61), multiple or days (-0.46)
J952	Acute pulmonary insufficiency following nonthoracic surgery	MCC	-1.206	1	680	multiple or days (-0.46), n j code lines (-0.29), length of stay (-0.26)

Top Codes by Tier

Tier 1 (n=138 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I9789	Other postprocedural complications and disorders of the circulatory system, not elsewhere classified	CC	-0.317	673	multiple or days (-0.24), icu (+0.14), work rvu (+0.08)
I4719	Other supraventricular tachycardia	No CC/MCC	-0.351	698	n imaging lines (-0.22), transfusion (+0.18), icu (-0.15)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	-0.368	3094	n j code lines (+0.14), multiple or days (-0.13), n imaging lines (-0.11)
F319	Bipolar disorder, unspecified	No CC/MCC	-0.425	608	relative claim charge (-0.15), organ system count (+0.12), n imaging lines (-0.10)
I4820	Chronic atrial fibrillation, unspecified	CC	-0.428	1414	n distinct rev codes (-0.14), n imaging lines (-0.13), n j code lines (+0.09)
J939	Pneumothorax, unspecified	CC	-0.473	1633	relative claim charge (-0.23), multiple or days (+0.22), n j code lines (+0.17)
I4710	Supraventricular tachycardia, unspecified	No CC/MCC	-0.482	1277	n imaging lines (-0.17), n j code lines (+0.16), organ system count (-0.10)
I083	Combined rheumatic disorders of mitral, aortic and tricuspid valves	No CC/MCC	-0.547	1587	n imaging lines (-0.16), mechanical ventilation (-0.15), n j code lines (-0.14)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	-0.553	3638	n j code lines (-0.26), multiple or days (-0.21), dialysis (+0.11)
E8770	Fluid overload, unspecified	No CC/MCC	-0.583	5494	n j code lines (+0.45), relative claim charge (-0.35), length of stay (-0.31)

Tier 2 (n=63 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J918	Pleural effusion in other conditions classified elsewhere	CC	3.212	774	length of stay (+0.83), relative claim charge (+0.49), n distinct rev codes (+0.46)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	3.178	2784	n distinct rev codes (+0.49), transfusion (+0.48), n imaging lines (+0.39)
F05	Delirium due to known physiological condition	CC	3.093	1985	length of stay (+0.53), n distinct rev codes (+0.45), relative claim charge (+0.42)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	2.678	670	length of stay (+0.64), n imaging lines (+0.44), n distinct rev codes (+0.40)
I7103	Dissection of thoracoabdominal aorta	MCC	2.639	1571	n imaging lines (+0.74), relative claim charge (+0.49), n j code lines (+0.43)
I7102	Dissection of abdominal aorta	MCC	2.612	515	n imaging lines (+0.81), mechanical ventilation (+0.41), relative claim charge (+0.35)
J95821	Acute postprocedural respiratory failure	MCC	2.404	1682	mechanical ventilation (+1.07), transfusion (+0.41), relative claim charge (+0.31)
D631	Anemia in chronic kidney disease	No CC/MCC	2.397	1447	dialysis (+0.89), length of stay (+0.36), n distinct rev codes (+0.32)
E874	Mixed disorder of acid-base balance	CC	2.217	1034	icu (+0.40), length of stay (+0.40), mechanical ventilation (+0.31)
E441	Mild protein-calorie malnutrition	CC	2.170	689	n distinct rev codes (+0.72), transfusion (+0.51), length of stay (+0.47)

Tier 3 (n=26 codes)

code	Description	CMS severity	Score	N claims	Key drivers
A419	Sepsis, unspecified organism	MCC	10.527	860	relative claim charge (+1.65), length of stay (+1.49), n imaging lines (+1.40)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.990	808	mechanical ventilation (+1.62), relative claim charge (+1.35), multiple or days (+1.31)
G928	Other toxic encephalopathy	No CC/MCC	8.670	871	n j code lines (+1.31), n imaging lines (+1.24), length of stay (+1.07)
T826XXA	Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter	CC	8.010	775	n imaging lines (+1.39), n distinct rev codes (+1.36), length of stay (+1.36)
K7200	Acute and subacute hepatic failure without coma	MCC	6.963	877	relative claim charge (+1.49), mechanical ventilation (+1.21), length of stay (+0.97)
G9340	Encephalopathy, unspecified	CC	6.881	898	n imaging lines (+1.15), mechanical ventilation (+1.13), n distinct rev codes (+0.97)
I330	Acute and subacute infective endocarditis	MCC	6.257	2250	n imaging lines (+1.27), n distinct rev codes (+1.11), length of stay (+1.03)
G9341	Metabolic encephalopathy	MCC	6.194	1388	n imaging lines (+1.10), relative claim charge (+0.99), mechanical ventilation (+0.96)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	6.034	693	relative claim charge (+1.10), multiple or days (+1.08), length of stay (+1.01)
N170	Acute kidney failure with tubular necrosis	MCC	5.912	3208	relative claim charge (+1.14), length of stay (+1.00), n distinct rev codes (+0.88)

Key Driver Frequency

feature	count	pct
n distinct rev codes	108	47.600
relative claim charge	98	43.200
length of stay	86	37.900
n imaging lines	78	34.400
n j code lines	72	31.700
transfusion	69	30.400
mechanical ventilation	59	26.000
multiple or days	59	26.000
icu	34	15.000
organ system count	7	3.100
work rvu	6	2.600
dialysis	5	2.200

PCS Codes

Data Overview

4724 total codes in komodo_rii; 102 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 43.9% of variance; PC1+PC2 together explain 58.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	n imaging lines	n j code lines	relative claim charge	mechanical ventilation	dialysis
1	45.000	223958.000	7.919	22.678	4.378	0.422	1.008	1.005	0.057	0.030
2	52.000	106046.000	10.622	25.420	4.921	0.593	1.426	1.167	0.106	0.047
3	5.000	6124.000	17.651	29.661	5.778	1.201	1.819	1.764	0.668	0.452

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_length_of_stay	0.379	-0.001
avg_n_distinct_rev_codes	0.364	-0.071
avg_relative_claim_charge	0.348	-0.165
avg_organ_system_count	0.318	0.048
avg_n_imaging_lines	0.314	-0.212
rate_multiple_or_days	0.290	-0.132
avg_n_j_code_lines	0.257	-0.118
rate_mechanical_ventilation	0.243	-0.046
rate_transfusion	0.239	-0.074
rate_dialysis	0.230	-0.122
avg_n_distinct_hcps	0.170	-0.208
rate_icu	0.165	-0.075
rate_or	0.140	-0.323
avg_work_rvu	0.093	-0.049

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=45 codes)

code	Description	Score	N claims	Key drivers
02VX3EZ	RESTRICTION OF THORACIC AORTA, ASCENDING/ARCH WITH BRANCHED OR FENESTRATED INTRALUMINAL DEVICE, ONE OR TWO ARTERIES, PERCUTANEOUS APPROACH	-0.592	860	n distinct rev codes (-0.53), transfusion (-0.47), n imaging lines (+0.47)
02UJ0JZ	SUPPLEMENT TRICUSPID VALVE WITH SYNTHETIC SUBSTITUTE, OPEN APPROACH	-0.629	3470	multiple or days (-0.31), n j code lines (-0.23), n imaging lines (-0.20)
021109W	BYPASS CORONARY ARTERY, TWO ARTERIES FROM AORTA WITH AUTOLOGOUS VENOUS TISSUE, OPEN APPROACH	-0.748	3902	n j code lines (-0.22), multiple or days (-0.19), n distinct hcps (-0.16)
02HK0JZ	INSERTION OF PACEMAKER LEAD INTO RIGHT VENTRICLE, OPEN APPROACH	-0.749	1006	icu (-0.23), n distinct hcps (-0.17), n imaging lines (-0.15)
02UX0JZ	SUPPLEMENT THORACIC AORTA, ASCENDING/ARCH WITH SYNTHETIC SUBSTITUTE, OPEN APPROACH	-0.811	1550	n imaging lines (-0.28), n j code lines (-0.23), multiple or days (-0.21)
027L0ZZ	DILATION OF LEFT VENTRICLE, OPEN APPROACH	-0.842	795	n imaging lines (-0.24), organ system count (-0.22), relative claim charge (-0.21)
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	-0.876	4645	relative claim charge (-0.24), n j code lines (+0.21), n imaging lines (-0.19)
B340ZZ3	ULTRASONOGRAPHY OF THORACIC AORTA, INTRAVASCULAR	-0.882	970	transfusion (-0.50), n imaging lines (+0.46), n distinct rev codes (-0.40)
02VX3DZ	RESTRICTION OF THORACIC AORTA, ASCENDING/ARCH WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-0.948	930	n distinct rev codes (-0.48), n imaging lines (+0.47), transfusion (-0.42)
02RG08Z	REPLACEMENT OF MITRAL VALVE WITH ZOOPLASTIC TISSUE, OPEN APPROACH	-0.949	7459	n distinct hcps (-0.25), n j code lines (-0.21), n imaging lines (-0.16)

Tier 2 (n=52 codes)

code	Description	Score	N claims	Key drivers
5A02210	ASSISTANCE WITH CARDIAC OUTPUT USING BALLOON PUMP, CONTINUOUS	3.487	968	relative claim charge (+0.81), length of stay (+0.72), n j code lines (+0.58)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	3.379	1039	multiple or days (+0.64), length of stay (+0.57), n distinct rev codes (+0.44)
0W9B30Z	DRAINAGE OF LEFT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	3.194	1034	multiple or days (+0.72), length of stay (+0.60), n imaging lines (+0.43)
02PA08Z	REMOVAL OF ZOOPLASTIC TISSUE FROM HEART, OPEN APPROACH	2.724	545	n distinct rev codes (+0.66), n imaging lines (+0.44), relative claim charge (+0.42)
02VW0DZ	RESTRICTION OF THORACIC AORTA, DESCENDING WITH INTRALUMINAL DEVICE, OPEN APPROACH	2.474	531	relative claim charge (+0.67), n imaging lines (+0.58), n distinct rev codes (+0.39)
5A0945A	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	2.399	802	multiple or days (+0.50), n distinct rev codes (+0.35), organ system count (+0.33)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	2.185	6230	multiple or days (+0.38), n j code lines (+0.37), length of stay (+0.31)
02NN0ZZ	RELEASE PERICARDIUM, OPEN APPROACH	2.130	1363	n distinct rev codes (+0.51), icu (+0.29), transfusion (+0.29)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	2.077	1159	length of stay (+0.48), n distinct rev codes (+0.37), organ system count (+0.34)
0W9930Z	DRAINAGE OF RIGHT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	1.901	1396	length of stay (+0.41), multiple or days (+0.39), n distinct rev codes (+0.27)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	11.349	899	relative claim charge (+1.78), length of stay (+1.66), n imaging lines (+1.37)
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	9.530	555	dialysis (+1.54), length of stay (+1.47), relative claim charge (+1.46)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	6.032	1550	mechanical ventilation (+1.22), n distinct rev codes (+0.73), length of stay (+0.72)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	5.597	1051	dialysis (+1.62), length of stay (+0.95), organ system count (+0.69)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.982	2069	mechanical ventilation (+0.99), length of stay (+0.78), relative claim charge (+0.71)

Key Driver Frequency

feature	count	pct
n distinct rev codes	40	39.200
n imaging lines	40	39.200
length of stay	36	35.300
relative claim charge	33	32.400
multiple or days	33	32.400
n j code lines	31	30.400
organ system count	24	23.500
n distinct hcps	23	22.500
transfusion	20	19.600
icu	13	12.700
work rvu	5	4.900
mechanical ventilation	4	3.900
or	2	2.000
dialysis	2	2.000