IP - CA.1.other_procedures

CM Codes

Data Overview

9510 total codes in komodo_rii; 304 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	157
CC	108
MCC	39

PCA Analysis

PC1 explains 39.4% of variance; PC1+PC2 together explain 54.9%.

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 imaging lines	n j code lines	work rvu	transfusion
1	174.000	483541.000	6.883	19.811	5.141	0.980	0.718	0.598	0.831	0.240
2	92.000	204101.000	10.086	22.700	5.521	1.182	0.874	0.802	1.023	0.382
3	38.000	58045.000	13.478	25.480	5.759	1.508	1.190	1.020	1.178	0.517

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	48	47	13	108
MCC	12	7	20	39
No CC/MCC	114	38	5	157
All	174	92	38	304

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.401	-0.153	0.427
avg_relative_claim_charge	0.391	-0.157	0.440
avg_length_of_stay	0.383	-0.110	0.364
rate_transfusion	0.325	-0.140	0.253
avg_n_imaging_lines	0.306	-0.193	0.478
rate_mechanical_ventilation	0.291	-0.067	0.306
rate_icu	0.257	-0.108	0.239
avg_n_j_code_lines	0.239	-0.035	0.219
rate_multiple_or_days	0.195	0.005	0.221
rate_dialysis	0.190	-0.013	0.286
avg_organ_system_count	0.169	-0.111	-0.236
avg_work_rvu	0.153	-0.091	0.004
avg_n_distinct_hcps	0.074	-0.207	-0.216
rate_or	-0.031	-0.077	-0.213

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	7.580	3	1234	relative claim charge (+1.21), length of stay (+1.21), n imaging lines (+1.17)
K683	Retroperitoneal hematoma	No CC/MCC	4.188	3	793	transfusion (+1.11), relative claim charge (+1.02), n imaging lines (+0.73)
E8729	Other acidosis	No CC/MCC	3.399	3	636	n distinct rev codes (+0.57), relative claim charge (+0.56), transfusion (+0.44)
D84821	Immunodeficiency due to drugs	No CC/MCC	3.121	3	689	n j code lines (+0.92), length of stay (+0.49), relative claim charge (+0.40)
D6959	Other secondary thrombocytopenia	No CC/MCC	3.113	3	675	n j code lines (+0.61), transfusion (+0.59), relative claim charge (+0.45)

Under-tiered: Tier 1, MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I213	ST elevation (STEMI) myocardial infarction of unspecified site	MCC	-1.283	1	1619	mechanical ventilation (+0.46), n imaging lines (-0.43), transfusion (-0.37)
I2119	ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall	MCC	-1.156	1	1545	n imaging lines (-0.44), mechanical ventilation (+0.43), length of stay (-0.42)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	-1.155	1	4742	n imaging lines (+0.43), transfusion (-0.30), length of stay (-0.30)
I82220	Acute embolism and thrombosis of inferior vena cava	MCC	-1.151	1	2702	icu (-0.32), multiple or days (+0.31), length of stay (-0.30)
I2692	Saddle embolus of pulmonary artery without acute cor pulmonale	MCC	-0.991	1	508	length of stay (-0.37), transfusion (-0.37), n imaging lines (+0.36)

Top Codes by Tier

Tier 1 (n=174 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9611	Chronic respiratory failure with hypoxia	CC	-0.255	954	work rvu (+0.21), relative claim charge (-0.15), mechanical ventilation (-0.13)
I7142	Juxtarenal abdominal aortic aneurysm, without rupture	No CC/MCC	-0.265	502	transfusion (+0.74), n imaging lines (-0.66), multiple or days (-0.42)
I350	Nonrheumatic aortic (valve) stenosis	No CC/MCC	-0.268	1341	n imaging lines (-0.26), multiple or days (-0.24), work rvu (+0.18)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	-0.280	5389	icu (+0.23), transfusion (-0.23), organ system count (-0.20)
L97419	Non-pressure chronic ulcer of right heel and midfoot with unspecified severity	CC	-0.310	523	multiple or days (-0.42), icu (-0.31), length of stay (+0.22)
Q210	Ventricular septal defect	CC	-0.327	669	transfusion (+0.97), organ system count (-0.72), n imaging lines (-0.64)
I671	Cerebral aneurysm, nonruptured	No CC/MCC	-0.336	610	work rvu (+0.78), length of stay (-0.63), n distinct rev codes (-0.61)
D6869	Other thrombophilia	CC	-0.340	629	n imaging lines (+0.21), mechanical ventilation (-0.16), work rvu (-0.11)
I5042	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	CC	-0.350	1430	n j code lines (-0.19), multiple or days (+0.19), mechanical ventilation (-0.12)
I309	Acute pericarditis, unspecified	CC	-0.350	618	relative claim charge (-0.52), n distinct rev codes (+0.38), icu (+0.32)

Tier 2 (n=92 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5023	Acute on chronic systolic (congestive) heart failure	MCC	2.821	3606	length of stay (+0.53), relative claim charge (+0.52), n j code lines (+0.41)
E861	Hypovolemia	No CC/MCC	2.681	1029	transfusion (+0.48), n j code lines (+0.40), n distinct rev codes (+0.38)
K921	Melena	CC	2.534	672	transfusion (+0.92), n distinct rev codes (+0.44), length of stay (+0.35)
I4901	Ventricular fibrillation	MCC	2.468	1283	mechanical ventilation (+1.23), icu (+0.43), relative claim charge (+0.42)
D849	Immunodeficiency, unspecified	CC	2.452	519	n j code lines (+0.47), n distinct rev codes (+0.43), length of stay (+0.38)
I2489	Other forms of acute ischemic heart disease	No CC/MCC	2.436	506	relative claim charge (+0.43), n distinct rev codes (+0.42), n imaging lines (+0.41)
J811	Chronic pulmonary edema	CC	2.434	673	transfusion (+0.46), relative claim charge (+0.44), mechanical ventilation (+0.44)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	2.432	897	length of stay (+0.57), n distinct rev codes (+0.50), relative claim charge (+0.36)
D6832	Hemorrhagic disorder due to extrinsic circulating anticoagulants	CC	2.300	558	transfusion (+0.70), n distinct rev codes (+0.42), relative claim charge (+0.38)
K567	Ileus, unspecified	CC	2.280	1448	length of stay (+0.47), transfusion (+0.44), relative claim charge (+0.43)

Tier 3 (n=38 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G928	Other toxic encephalopathy	No CC/MCC	7.580	1234	relative claim charge (+1.21), length of stay (+1.21), n imaging lines (+1.17)
I330	Acute and subacute infective endocarditis	MCC	6.921	544	length of stay (+1.27), n imaging lines (+1.13), n distinct rev codes (+0.99)
J690	Pneumonitis due to inhalation of food and vomit	MCC	6.592	1642	relative claim charge (+1.25), mechanical ventilation (+1.05), n distinct rev codes (+0.95)
A419	Sepsis, unspecified organism	MCC	6.381	2902	relative claim charge (+1.25), n distinct rev codes (+0.96), length of stay (+0.91)
G9341	Metabolic encephalopathy	MCC	6.305	2697	relative claim charge (+1.03), n imaging lines (+0.98), n distinct rev codes (+0.94)
N170	Acute kidney failure with tubular necrosis	MCC	6.166	3347	relative claim charge (+1.10), n distinct rev codes (+0.93), length of stay (+0.89)
G9340	Encephalopathy, unspecified	CC	5.925	958	relative claim charge (+1.05), n imaging lines (+0.94), n distinct rev codes (+0.93)
E873	Alkalosis	CC	5.807	600	multiple or days (+0.99), length of stay (+0.79), n distinct rev codes (+0.78)
E870	Hyperosmolality and hypernatremia	CC	5.688	1158	relative claim charge (+1.38), length of stay (+1.03), n distinct rev codes (+0.93)
E874	Mixed disorder of acid-base balance	CC	5.600	644	relative claim charge (+1.14), length of stay (+1.02), mechanical ventilation (+0.95)

Key Driver Frequency

feature	count	pct
n distinct rev codes	181	59.500
length of stay	152	50.000
relative claim charge	145	47.700
n imaging lines	91	29.900
transfusion	82	27.000
icu	65	21.400
n j code lines	51	16.800
mechanical ventilation	45	14.800
multiple or days	43	14.100
organ system count	24	7.900
work rvu	22	7.200
dialysis	9	3.000
n distinct hcps	2	0.700

PCS Codes

Data Overview

8385 total codes in komodo_rii; 179 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 46.8% of variance; PC1+PC2 together explain 60.6%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	work rvu	relative claim charge	n j code lines	n imaging lines	transfusion
1	35.000	55360.000	5.246	18.310	4.252	0.537	0.929	0.512	0.707	0.204
2	87.000	192929.000	7.482	20.628	4.787	0.764	1.081	0.651	0.752	0.249
3	22.000	22728.000	9.503	22.872	5.071	0.952	1.217	0.876	0.887	0.396
4	32.000	48902.000	12.431	25.280	5.381	1.304	1.447	1.136	1.031	0.539
5	3.000	2443.000	17.260	28.885	5.807	1.977	2.075	1.539	1.398	0.761

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.365	-0.147
avg_length_of_stay	0.354	-0.104
avg_relative_claim_charge	0.334	-0.185
rate_transfusion	0.307	-0.223
avg_n_j_code_lines	0.276	-0.116
avg_organ_system_count	0.272	-0.080
rate_icu	0.254	-0.144
avg_n_imaging_lines	0.246	-0.186
rate_mechanical_ventilation	0.245	-0.149
avg_work_rvu	0.242	-0.142
rate_dialysis	0.226	0.010
rate_multiple_or_days	0.222	0.041
avg_n_distinct_hcps	0.203	-0.120
rate_or	0.007	-0.144

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=35 codes)

code	Description	Score	N claims	Key drivers
067D3DZ	DILATION OF LEFT COMMON ILIAC VEIN WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-1.907	2130	icu (-0.38), length of stay (-0.36), n distinct rev codes (-0.35)
06CC3ZZ	EXTIRPATION OF MATTER FROM RIGHT COMMON ILIAC VEIN, PERCUTANEOUS APPROACH	-1.967	1869	icu (-0.32), n distinct rev codes (-0.32), relative claim charge (-0.30)
04UK0KZ	SUPPLEMENT RIGHT FEMORAL ARTERY WITH NONAUTOLOGOUS TISSUE SUBSTITUTE, OPEN APPROACH	-2.070	2013	n imaging lines (-0.35), n distinct hcps (-0.35), relative claim charge (-0.29)
047C3DZ	DILATION OF RIGHT COMMON ILIAC ARTERY WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-2.108	1640	multiple or days (-0.31), n distinct rev codes (-0.28), n j code lines (-0.27)
067G3DZ	DILATION OF LEFT EXTERNAL ILIAC VEIN WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-2.228	916	icu (-0.40), length of stay (-0.31), organ system count (-0.31)
04UL3KZ	SUPPLEMENT LEFT FEMORAL ARTERY WITH NONAUTOLOGOUS TISSUE SUBSTITUTE, PERCUTANEOUS APPROACH	-2.236	540	n imaging lines (-0.39), n distinct rev codes (-0.32), relative claim charge (-0.31)
X2CY3T7	EXTIRPATION OF MATTER FROM GREAT VESSEL USING COMPUTER-AIDED MECHANICAL ASPIRATION, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 7	-2.241	745	length of stay (-0.41), organ system count (-0.41), n distinct rev codes (-0.33)
02LR3DT	OCCLUSION OF DUCTUS ARTERIOSUS WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-2.251	544	organ system count (-1.40), relative claim charge (+0.90), icu (-0.78)
B5191ZZ	FLUOROSCOPY OF INFERIOR VENA CAVA USING LOW OSMOLAR CONTRAST	-2.345	2357	length of stay (-0.34), relative claim charge (-0.33), icu (-0.32)
06CD3ZZ	EXTIRPATION OF MATTER FROM LEFT COMMON ILIAC VEIN, PERCUTANEOUS APPROACH	-2.359	3980	n distinct rev codes (-0.39), length of stay (-0.37), icu (-0.35)

Tier 2 (n=87 codes)

code	Description	Score	N claims	Key drivers
3E05317	INTRODUCTION OF OTHER THROMBOLYTIC INTO PERIPHERAL ARTERY, PERCUTANEOUS APPROACH	0.057	3951	multiple or days (+0.31), icu (+0.25), length of stay (-0.20)
047T3ZZ	DILATION OF RIGHT PERONEAL ARTERY, PERCUTANEOUS APPROACH	-0.055	1346	multiple or days (+0.31), icu (-0.27), n j code lines (-0.19)
4A023N8	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, BILATERAL, PERCUTANEOUS APPROACH	-0.083	2940	organ system count (-0.38), n distinct hcps (+0.20), mechanical ventilation (+0.19)
04CR3ZZ	EXTIRPATION OF MATTER FROM RIGHT POSTERIOR TIBIAL ARTERY, PERCUTANEOUS APPROACH	-0.132	1764	n j code lines (-0.19), organ system count (+0.17), mechanical ventilation (-0.12)
04CP3ZZ	EXTIRPATION OF MATTER FROM RIGHT ANTERIOR TIBIAL ARTERY, PERCUTANEOUS APPROACH	-0.140	2125	icu (-0.20), organ system count (+0.17), n j code lines (-0.17)
04CU3ZZ	EXTIRPATION OF MATTER FROM LEFT PERONEAL ARTERY, PERCUTANEOUS APPROACH	-0.167	1475	transfusion (-0.18), icu (-0.16), multiple or days (+0.12)
04CS3ZZ	EXTIRPATION OF MATTER FROM LEFT POSTERIOR TIBIAL ARTERY, PERCUTANEOUS APPROACH	-0.171	1805	n j code lines (-0.15), icu (-0.14), transfusion (-0.14)
047Q3ZZ	DILATION OF LEFT ANTERIOR TIBIAL ARTERY, PERCUTANEOUS APPROACH	-0.237	2146	icu (-0.20), organ system count (+0.18), length of stay (+0.17)
027135Z	DILATION OF CORONARY ARTERY, TWO ARTERIES WITH TWO DRUG-ELUTING INTRALUMINAL DEVICES, PERCUTANEOUS APPROACH	-0.255	636	transfusion (-0.24), relative claim charge (+0.23), n imaging lines (-0.22)
X2CT3T7	EXTIRPATION OF MATTER FROM LEFT LOWER EXTREMITY ARTERY USING COMPUTER-AIDED MECHANICAL ASPIRATION, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 7	-0.267	1066	work rvu (+0.24), multiple or days (-0.16), icu (+0.14)

Tier 3 (n=22 codes)

code	Description	Score	N claims	Key drivers
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	2.219	1513	mechanical ventilation (+1.37), icu (+0.34), transfusion (+0.23)
04L33DZ	OCCLUSION OF HEPATIC ARTERY WITH INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	2.117	649	transfusion (+0.62), n imaging lines (+0.57), n distinct rev codes (+0.42)
4A133J1	MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH	2.041	1093	n j code lines (+0.56), icu (+0.24), n distinct rev codes (+0.24)
0W9D30Z	DRAINAGE OF PERICARDIAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	2.008	546	n distinct rev codes (+0.59), length of stay (+0.37), icu (+0.30)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	1.993	596	n distinct rev codes (+0.42), length of stay (+0.28), organ system count (+0.27)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	1.927	1445	n j code lines (+0.41), relative claim charge (+0.31), icu (+0.25)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.889	1949	n distinct rev codes (+0.37), n distinct hcps (+0.28), icu (+0.27)
B4141ZZ	FLUOROSCOPY OF SUPERIOR MESENTERIC ARTERY USING LOW OSMOLAR CONTRAST	1.800	628	transfusion (+0.47), n imaging lines (+0.38), organ system count (+0.26)
06BP0ZZ	EXCISION OF RIGHT SAPHENOUS VEIN, OPEN APPROACH	1.708	505	work rvu (+0.48), multiple or days (+0.46), transfusion (+0.38)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	1.404	1427	icu (+0.31), n distinct rev codes (+0.31), mechanical ventilation (+0.24)

Tier 4 (n=32 codes)

code	Description	Score	N claims	Key drivers
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	5.633	574	n j code lines (+0.82), relative claim charge (+0.72), n distinct rev codes (+0.54)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	5.379	1298	n distinct hcps (+0.62), work rvu (+0.58), n j code lines (+0.57)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	5.244	814	dialysis (+0.86), n distinct rev codes (+0.73), length of stay (+0.72)
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	5.166	894	transfusion (+1.16), n distinct rev codes (+0.61), length of stay (+0.54)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	5.071	2181	mechanical ventilation (+1.37), n distinct rev codes (+0.65), relative claim charge (+0.48)
30233R1	TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	5.013	771	transfusion (+1.13), n distinct rev codes (+0.55), relative claim charge (+0.53)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.986	3538	mechanical ventilation (+1.13), relative claim charge (+0.74), n distinct rev codes (+0.61)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	4.858	1040	dialysis (+1.30), length of stay (+1.00), organ system count (+0.68)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	4.617	1139	transfusion (+0.79), length of stay (+0.71), n distinct rev codes (+0.70)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	4.502	567	length of stay (+0.92), n distinct rev codes (+0.87), n imaging lines (+0.59)

Tier 5 (n=3 codes)

code	Description	Score	N claims	Key drivers
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	9.429	518	dialysis (+1.34), relative claim charge (+1.07), length of stay (+1.05)
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	8.958	1415	relative claim charge (+1.89), mechanical ventilation (+1.37), n distinct rev codes (+0.99)
0W3P8ZZ	CONTROL BLEEDING IN GASTROINTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	7.631	510	length of stay (+1.29), n distinct rev codes (+1.07), transfusion (+1.01)

Key Driver Frequency

feature	count	pct
n distinct rev codes	83	46.400
icu	64	35.800
length of stay	60	33.500
relative claim charge	54	30.200
transfusion	49	27.400
n j code lines	49	27.400
n imaging lines	36	20.100
organ system count	33	18.400
work rvu	32	17.900
n distinct hcps	32	17.900
multiple or days	31	17.300
mechanical ventilation	9	5.000
dialysis	5	2.800