IP - CA.1.other_circulatory

CM Codes

Data Overview

12532 total codes in komodo_rii; 424 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	230
CC	153
MCC	41

PCA Analysis

PC1 explains 42.4% of variance; PC1+PC2 together explain 58.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	relative claim charge	n j code lines	work rvu	n imaging lines	transfusion
1	221.000	776365.000	5.968	15.829	5.847	0.949	0.588	0.770	0.780	0.099
2	155.000	486578.000	7.656	17.554	6.350	1.153	0.771	0.859	0.915	0.182
3	48.000	104604.000	10.971	20.441	6.649	1.691	1.062	1.205	1.209	0.294

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	72	63	18	153
MCC	3	13	25	41
No CC/MCC	146	79	5	230
All	221	155	48	424

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.385	0.025	0.350
avg_length_of_stay	0.375	-0.066	0.360
avg_relative_claim_charge	0.367	-0.073	0.409
rate_transfusion	0.307	0.031	0.391
rate_mechanical_ventilation	0.300	0.034	0.489
avg_n_imaging_lines	0.274	-0.078	0.215
rate_or	0.259	-0.006	0.357
rate_icu	0.218	0.126	0.266
rate_multiple_or_days	0.210	-0.007	0.124
avg_organ_system_count	0.205	-0.057	-0.165
avg_n_j_code_lines	0.204	-0.062	0.153
avg_n_distinct_hcps	0.175	-0.119	-0.088
rate_dialysis	0.159	0.154	0.220
avg_work_rvu	0.140	-0.038	0.018

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
G928	Other toxic encephalopathy	No CC/MCC	7.999	3	2978	relative claim charge (+1.23), n distinct rev codes (+1.23), n imaging lines (+1.12)
I953	Hypotension of hemodialysis	No CC/MCC	4.681	3	892	dialysis (+0.71), n distinct hcps (+0.59), n distinct rev codes (+0.57)
E8729	Other acidosis	No CC/MCC	3.775	3	1062	mechanical ventilation (+0.76), relative claim charge (+0.64), n distinct rev codes (+0.63)
L89152	Pressure ulcer of sacral region, stage 2	No CC/MCC	3.476	3	536	length of stay (+0.75), n distinct rev codes (+0.61), organ system count (+0.40)
D6959	Other secondary thrombocytopenia	No CC/MCC	3.364	3	1790	transfusion (+0.63), n distinct rev codes (+0.54), length of stay (+0.47)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	-4.937	1	667	n distinct hcps (-0.74), or (-0.61), length of stay (-0.56)
I400	Infective myocarditis	MCC	-4.526	1	719	n distinct rev codes (-0.77), organ system count (-0.75), length of stay (-0.71)
I5031	Acute diastolic (congestive) heart failure	MCC	-0.677	1	1264	organ system count (-0.29), n distinct rev codes (+0.20), transfusion (-0.19)

Top Codes by Tier

Tier 1 (n=221 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1065	Type 1 diabetes mellitus with hyperglycemia	No CC/MCC	-0.464	518	dialysis (+0.28), organ system count (+0.20), n imaging lines (-0.18)
I69354	Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side	CC	-0.467	1670	multiple or days (-0.27), n imaging lines (+0.20), n j code lines (-0.20)
D6869	Other thrombophilia	CC	-0.483	995	n distinct hcps (-0.22), mechanical ventilation (-0.15), n j code lines (+0.15)
E1140	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	No CC/MCC	-0.491	3405	relative claim charge (-0.18), mechanical ventilation (-0.17), length of stay (-0.14)
F840	Autistic disorder	CC	-0.547	543	n imaging lines (-0.34), n distinct hcps (+0.27), n distinct rev codes (-0.25)
F39	Unspecified mood [affective] disorder	No CC/MCC	-0.553	1044	relative claim charge (-0.25), multiple or days (+0.22), n distinct rev codes (-0.20)
E1143	Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy	No CC/MCC	-0.566	994	multiple or days (-0.30), organ system count (+0.26), n j code lines (-0.19)
N401	Benign prostatic hyperplasia with lower urinary tract symptoms	No CC/MCC	-0.568	1474	multiple or days (+0.18), length of stay (-0.18), transfusion (-0.18)
K912	Postsurgical malabsorption, not elsewhere classified	CC	-0.597	1526	length of stay (+0.48), or (+0.45), n imaging lines (-0.45)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	-0.600	4890	length of stay (-0.17), n j code lines (-0.16), relative claim charge (-0.16)

Tier 2 (n=155 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D61810	Antineoplastic chemotherapy induced pancytopenia	MCC	2.965	2233	transfusion (+1.61), n distinct rev codes (+0.41), length of stay (+0.31)
T826XXA	Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter	CC	2.931	3788	length of stay (+0.75), n imaging lines (+0.64), n distinct rev codes (+0.60)
T80211A	Bloodstream infection due to central venous catheter, initial encounter	CC	2.683	28116	or (+0.61), length of stay (+0.44), n distinct rev codes (+0.44)
J189	Pneumonia, unspecified organism	MCC	2.637	8799	n distinct rev codes (+0.57), relative claim charge (+0.37), n imaging lines (+0.34)
E43	Unspecified severe protein-calorie malnutrition	MCC	2.609	9060	length of stay (+0.63), n distinct rev codes (+0.51), relative claim charge (+0.51)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	2.592	6329	relative claim charge (+0.60), mechanical ventilation (+0.60), icu (+0.57)
N136	Pyonephrosis	CC	2.502	543	n distinct rev codes (+0.54), n imaging lines (+0.39), transfusion (+0.39)
K766	Portal hypertension	CC	2.440	1491	transfusion (+0.46), n distinct rev codes (+0.34), n distinct hcps (+0.25)
D61818	Other pancytopenia	CC	2.349	3989	transfusion (+0.89), n distinct rev codes (+0.36), length of stay (+0.33)
E46	Unspecified protein-calorie malnutrition	CC	2.256	2478	length of stay (+0.54), n distinct rev codes (+0.34), transfusion (+0.31)

Tier 3 (n=48 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I2690	Septic pulmonary embolism without acute cor pulmonale	MCC	9.023	785	length of stay (+1.49), relative claim charge (+1.18), n distinct rev codes (+1.16)
K7200	Acute and subacute hepatic failure without coma	MCC	8.828	1049	mechanical ventilation (+2.25), relative claim charge (+1.41), n distinct rev codes (+1.23)
J9602	Acute respiratory failure with hypercapnia	MCC	8.667	1200	mechanical ventilation (+2.22), relative claim charge (+1.34), n distinct rev codes (+1.21)
J690	Pneumonitis due to inhalation of food and vomit	MCC	8.597	2088	mechanical ventilation (+1.66), relative claim charge (+1.28), length of stay (+1.22)
I76	Septic arterial embolism	CC	8.090	990	n imaging lines (+1.39), length of stay (+1.28), relative claim charge (+1.26)
G928	Other toxic encephalopathy	No CC/MCC	7.999	2978	relative claim charge (+1.23), n distinct rev codes (+1.23), n imaging lines (+1.12)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	7.794	609	mechanical ventilation (+1.90), n j code lines (+0.96), relative claim charge (+0.92)
K567	Ileus, unspecified	CC	7.371	618	length of stay (+1.33), relative claim charge (+1.14), n j code lines (+1.08)
A4102	Sepsis due to Methicillin resistant Staphylococcus aureus	MCC	7.207	3861	n distinct rev codes (+1.19), relative claim charge (+1.15), length of stay (+1.05)
B377	Candidal sepsis	MCC	7.004	1236	length of stay (+1.46), relative claim charge (+1.33), n distinct rev codes (+0.94)

Key Driver Frequency

feature	count	pct
n distinct rev codes	201	47.400
relative claim charge	184	43.400
length of stay	183	43.200
or	116	27.400
transfusion	89	21.000
organ system count	86	20.300
n imaging lines	77	18.200
multiple or days	74	17.500
icu	71	16.700
n distinct hcps	56	13.200
n j code lines	48	11.300
mechanical ventilation	39	9.200
dialysis	30	7.100
work rvu	18	4.200

PCS Codes

Data Overview

3049 total codes in komodo_rii; 73 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 35.6% of variance; PC1+PC2 together explain 56.4%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	relative claim charge	n imaging lines	work rvu	icu	mechanical ventilation
1	2.000	1411.000	1.474	13.619	1.440	1.450	0.191	0.097	0.036	0.139
2	20.000	56543.000	7.625	18.249	5.512	1.364	0.836	0.555	0.383	0.052
3	38.000	100641.000	9.454	20.276	6.004	1.665	0.985	0.703	0.444	0.106
4	11.000	12721.000	10.983	22.365	5.845	2.422	1.383	1.243	0.629	0.346
5	2.000	1984.000	14.507	24.899	6.255	3.760	1.490	1.081	0.753	0.683

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.424	-0.011
avg_length_of_stay	0.389	-0.088
avg_n_imaging_lines	0.363	-0.157
avg_relative_claim_charge	0.356	-0.118
rate_icu	0.332	-0.063
rate_transfusion	0.272	-0.092
avg_work_rvu	0.239	-0.032
avg_organ_system_count	0.238	0.128
rate_mechanical_ventilation	0.231	-0.180
rate_multiple_or_days	0.153	0.116
avg_n_distinct_hcps	0.133	0.174
avg_n_j_code_lines	0.088	-0.045
rate_dialysis	0.087	0.087
rate_or	0.060	0.250

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=2 codes)

code	Description	Score	N claims	Key drivers
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-6.650	848	n distinct rev codes (-1.37), length of stay (-1.26), organ system count (-1.01)
0VTTXZZ	RESECTION OF PREPUCE, EXTERNAL APPROACH	-7.363	563	length of stay (-1.49), n distinct rev codes (-1.27), organ system count (-1.20)

Tier 2 (n=20 codes)

code	Description	Score	N claims	Key drivers
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.932	4390	length of stay (-0.24), n distinct rev codes (-0.23), transfusion (-0.19)
05PYX3Z	REMOVAL OF INFUSION DEVICE FROM UPPER VEIN, EXTERNAL APPROACH	-0.948	1897	icu (-0.24), relative claim charge (-0.20), organ system count (+0.19)
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	-1.093	555	work rvu (-0.27), n distinct hcps (-0.26), relative claim charge (-0.20)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	-1.208	1578	n distinct hcps (-0.25), n distinct rev codes (-0.24), work rvu (-0.21)
0JPT0WZ	REMOVAL OF TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICE FROM TRUNK SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-1.222	4074	icu (-0.37), relative claim charge (-0.26), n distinct rev codes (-0.21)
05PY33Z	REMOVAL OF INFUSION DEVICE FROM UPPER VEIN, PERCUTANEOUS APPROACH	-1.248	1249	icu (-0.28), relative claim charge (-0.23), n imaging lines (-0.21)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	-1.367	1187	length of stay (-0.38), n distinct rev codes (-0.30), icu (+0.26)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-1.398	23710	relative claim charge (-0.31), n distinct rev codes (-0.29), n imaging lines (-0.27)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	-1.551	2454	n distinct rev codes (-0.48), n imaging lines (-0.46), icu (-0.44)
0JPT3WZ	REMOVAL OF TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICE FROM TRUNK SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	-1.620	890	icu (-0.39), n distinct rev codes (-0.30), relative claim charge (-0.30)

Tier 3 (n=38 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.307	6712	transfusion (+1.03), n distinct rev codes (+0.16), length of stay (+0.13)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.191	948	n distinct rev codes (+0.45), n imaging lines (+0.34), multiple or days (+0.32)
5A12012	PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL	1.063	751	mechanical ventilation (+0.46), icu (+0.40), n imaging lines (+0.22)
0DJD8ZZ	INSPECTION OF LOWER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.944	545	length of stay (+0.36), n distinct rev codes (+0.36), transfusion (+0.35)
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	0.867	1314	relative claim charge (+0.31), n distinct rev codes (+0.20), mechanical ventilation (+0.13)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.866	2310	icu (+0.69), n imaging lines (+0.24), length of stay (-0.14)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	0.797	1350	length of stay (+0.17), n distinct rev codes (+0.13), n j code lines (+0.12)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	0.605	1431	n distinct rev codes (+0.40), n imaging lines (+0.24), icu (+0.16)
02PAX3Z	REMOVAL OF INFUSION DEVICE FROM HEART, EXTERNAL APPROACH	0.588	898	organ system count (+0.25), length of stay (+0.24), n distinct rev codes (+0.24)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	0.588	579	work rvu (+1.10), multiple or days (+0.56), n j code lines (+0.56)

Tier 4 (n=11 codes)

code	Description	Score	N claims	Key drivers
4A133J1	MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH	3.871	534	icu (+0.67), n distinct rev codes (+0.64), work rvu (+0.61)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	3.862	1442	mechanical ventilation (+0.89), n distinct rev codes (+0.63), icu (+0.61)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	3.740	687	icu (+0.68), work rvu (+0.59), relative claim charge (+0.58)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	3.494	1694	icu (+0.68), relative claim charge (+0.51), n distinct rev codes (+0.50)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	3.301	2966	relative claim charge (+0.78), mechanical ventilation (+0.75), n distinct rev codes (+0.59)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	3.253	1361	icu (+0.77), n imaging lines (+0.42), work rvu (+0.42)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	2.877	612	n imaging lines (+1.26), n distinct rev codes (+0.62), relative claim charge (+0.34)
30243N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	2.302	647	transfusion (+1.07), length of stay (+0.64), relative claim charge (+0.30)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	2.157	704	n imaging lines (+1.07), relative claim charge (+0.61), n distinct rev codes (+0.53)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.925	1196	n distinct rev codes (+0.51), length of stay (+0.44), transfusion (+0.33)

Tier 5 (n=2 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	6.646	1273	relative claim charge (+1.78), length of stay (+1.14), n distinct rev codes (+1.01)
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	5.504	711	n distinct rev codes (+1.02), relative claim charge (+0.85), length of stay (+0.81)

Key Driver Frequency

feature	count	pct
n distinct rev codes	40	54.800
length of stay	31	42.500
relative claim charge	30	41.100
icu	29	39.700
n imaging lines	24	32.900
organ system count	20	27.400
work rvu	15	20.500
multiple or days	10	13.700
transfusion	6	8.200
n distinct hcps	6	8.200
mechanical ventilation	6	8.200
n j code lines	2	2.700