IP - DE.1.minor_skin

CM Codes

Data Overview

8844 total codes in komodo_rii; 102 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	89
CC	11
MCC	2

PCA Analysis

PC1 explains 50.9% of variance; PC1+PC2 together explain 63.2%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	work rvu	n j code lines	n imaging lines	n distinct hcps
1	17.000	109453.000	5.382	0.400	1.141	0.694	0.344	0.319	0.022	0.682
2	15.000	21350.000	9.720	4.391	4.010	1.440	0.685	0.676	0.241	0.766
3	46.000	69513.000	12.700	5.509	5.891	1.748	0.870	0.734	0.512	0.815
4	24.000	26938.000	14.119	6.833	5.992	2.209	1.030	1.024	0.649	0.849

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	0	0	5	6	11
MCC	0	0	0	2	2
No CC/MCC	17	15	41	16	89
All	17	15	46	24	102

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_imaging_lines	0.357	-0.051	0.289
avg_n_distinct_rev_codes	0.351	-0.002	0.436
rate_icu	0.330	-0.071	0.265
avg_organ_system_count	0.329	-0.051	0.083
avg_relative_claim_charge	0.315	0.079	0.361
rate_transfusion	0.303	-0.032	0.325
avg_length_of_stay	0.297	-0.112	0.382
rate_or	0.262	0.100	0.099
avg_n_j_code_lines	0.244	-0.091	0.158
avg_n_distinct_hcps	0.197	-0.137	0.216
rate_multiple_or_days	0.190	0.063	0.227
avg_work_rvu	0.183	-0.028	0.040
rate_dialysis	0.109	-0.062	0.286
rate_mechanical_ventilation	0.062	0.143	0.143

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I959	Hypotension, unspecified	No CC/MCC	4.311	4	661	icu (+0.74), transfusion (+0.59), relative claim charge (+0.50)
K5900	Constipation, unspecified	No CC/MCC	3.530	4	891	n j code lines (+0.68), n imaging lines (+0.42), work rvu (+0.41)
E8809	Other disorders of plasma-protein metabolism, not elsewhere classified	No CC/MCC	3.529	4	561	n j code lines (+0.76), transfusion (+0.67), multiple or days (+0.47)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	3.426	4	703	transfusion (+0.94), n j code lines (+0.51), n imaging lines (+0.41)
E8342	Hypomagnesemia	No CC/MCC	3.383	4	788	relative claim charge (+0.81), transfusion (+0.50), n j code lines (+0.40)

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

None.

Top Codes by Tier

Tier 1 (n=17 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D1801	Hemangioma of skin and subcutaneous tissue	No CC/MCC	-3.371	2457	organ system count (-0.61), icu (-0.52), length of stay (-0.51)
B000	Eczema herpeticum	No CC/MCC	-3.952	642	n imaging lines (-0.59), or (-0.55), icu (-0.50)
Q381	Ankyloglossia	No CC/MCC	-4.068	1219	organ system count (-0.76), n imaging lines (-0.64), icu (-0.56)
D224	Melanocytic nevi of scalp and neck	No CC/MCC	-4.475	614	organ system count (-0.65), n imaging lines (-0.63), icu (-0.57)
L813	Cafe au lait spots	No CC/MCC	-4.494	1217	organ system count (-0.65), n imaging lines (-0.65), icu (-0.58)
D2239	Melanocytic nevi of other parts of face	No CC/MCC	-4.496	623	n imaging lines (-0.65), organ system count (-0.65), icu (-0.58)
D225	Melanocytic nevi of trunk	No CC/MCC	-4.683	1074	n imaging lines (-0.64), n distinct rev codes (-0.64), organ system count (-0.63)
Q826	Congenital sacral dimple	No CC/MCC	-4.725	24313	organ system count (-0.83), n imaging lines (-0.64), icu (-0.58)
Q848	Other specified congenital malformations of integument	No CC/MCC	-4.728	964	organ system count (-0.82), icu (-0.57), n imaging lines (-0.57)
Q828	Other specified congenital malformations of skin	No CC/MCC	-4.776	40053	organ system count (-0.83), n imaging lines (-0.65), icu (-0.57)

Tier 2 (n=15 codes)

code	Description	CMS severity	Score	N claims	Key drivers
T368X5A	Adverse effect of other systemic antibiotics, initial encounter	No CC/MCC	-0.784	822	or (-0.29), icu (+0.23), relative claim charge (-0.21)
I872	Venous insufficiency (chronic) (peripheral)	No CC/MCC	-0.972	800	or (-0.45), transfusion (-0.21), n imaging lines (-0.16)
L539	Erythematous condition, unspecified	No CC/MCC	-0.984	502	transfusion (-0.25), or (-0.19), icu (-0.18)
L500	Allergic urticaria	No CC/MCC	-0.992	515	or (-0.45), n j code lines (+0.41), icu (+0.34)
B009	Herpesviral infection, unspecified	No CC/MCC	-1.113	527	or (+0.33), organ system count (-0.29), n imaging lines (-0.28)
L308	Other specified dermatitis	No CC/MCC	-1.205	605	or (-0.27), n imaging lines (-0.19), transfusion (-0.18)
L299	Pruritus, unspecified	No CC/MCC	-1.298	1294	or (-0.28), relative claim charge (-0.20), transfusion (-0.19)
L22	Diaper dermatitis	No CC/MCC	-1.346	6906	relative claim charge (+1.12), organ system count (-0.63), n imaging lines (-0.61)
I890	Lymphedema, not elsewhere classified	No CC/MCC	-1.361	3904	or (-0.34), n j code lines (-0.28), n distinct hcps (-0.21)
L309	Dermatitis, unspecified	No CC/MCC	-1.848	1333	n imaging lines (-0.26), transfusion (-0.26), or (-0.25)

Tier 3 (n=46 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N189	Chronic kidney disease, unspecified	No CC/MCC	1.826	652	transfusion (+0.39), work rvu (+0.31), organ system count (+0.25)
F32A	Depression, unspecified	No CC/MCC	1.805	2005	or (+0.35), n imaging lines (+0.24), organ system count (+0.24)
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	1.526	1280	n distinct rev codes (+0.32), icu (+0.31), length of stay (+0.27)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	1.482	1848	icu (+0.38), organ system count (+0.20), n imaging lines (+0.18)
G4700	Insomnia, unspecified	No CC/MCC	1.477	528	organ system count (+0.31), n imaging lines (+0.21), multiple or days (+0.18)
M793	Panniculitis, unspecified	No CC/MCC	1.437	755	n imaging lines (+0.44), or (+0.41), relative claim charge (+0.28)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	1.393	1434	or (+0.28), n imaging lines (+0.26), n distinct rev codes (+0.22)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	1.351	2983	organ system count (+0.30), or (+0.28), multiple or days (+0.21)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	1.330	1828	n distinct rev codes (+0.24), icu (+0.23), organ system count (+0.23)
L732	Hidradenitis suppurativa	No CC/MCC	1.301	2740	or (+0.63), transfusion (+0.44), n imaging lines (+0.28)

Tier 4 (n=24 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E43	Unspecified severe protein-calorie malnutrition	MCC	5.047	826	transfusion (+0.88), n imaging lines (+0.82), multiple or days (+0.65)
E440	Moderate protein-calorie malnutrition	CC	4.406	533	relative claim charge (+0.63), n imaging lines (+0.62), transfusion (+0.59)
I959	Hypotension, unspecified	No CC/MCC	4.311	661	icu (+0.74), transfusion (+0.59), relative claim charge (+0.50)
K5900	Constipation, unspecified	No CC/MCC	3.530	891	n j code lines (+0.68), n imaging lines (+0.42), work rvu (+0.41)
E8809	Other disorders of plasma-protein metabolism, not elsewhere classified	No CC/MCC	3.529	561	n j code lines (+0.76), transfusion (+0.67), multiple or days (+0.47)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	3.426	703	transfusion (+0.94), n j code lines (+0.51), n imaging lines (+0.41)
E8342	Hypomagnesemia	No CC/MCC	3.383	788	relative claim charge (+0.81), transfusion (+0.50), n j code lines (+0.40)
N186	End stage renal disease	MCC	3.379	722	dialysis (+0.96), transfusion (+0.59), icu (+0.47)
E875	Hyperkalemia	No CC/MCC	2.927	591	icu (+0.54), relative claim charge (+0.41), n distinct rev codes (+0.35)
N390	Urinary tract infection, site not specified	CC	2.892	1026	multiple or days (+0.54), work rvu (+0.41), n j code lines (+0.36)

Key Driver Frequency

feature	count	pct
n imaging lines	52	51.000
icu	42	41.200
organ system count	38	37.300
or	34	33.300
n distinct rev codes	28	27.500
transfusion	28	27.500
relative claim charge	21	20.600
n j code lines	20	19.600
multiple or days	14	13.700
work rvu	14	13.700
n distinct hcps	7	6.900
length of stay	6	5.900
dialysis	2	2.000

PCS Codes

Data Overview

1601 total codes in komodo_rii; 19 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 63.2% of variance; PC1+PC2 together explain 79.1%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	n j code lines	work rvu	n imaging lines	transfusion
1	5.000	8832.000	5.452	0.204	0.869	0.129	0.129	0.002	0.005	0.021
2	5.000	59001.000	9.384	0.436	2.068	0.440	0.398	0.028	0.020	0.018
3	5.000	4493.000	14.429	1.302	5.197	0.913	0.601	0.177	0.073	0.045
4	2.000	1445.000	15.081	1.665	4.999	1.486	0.430	0.222	0.340	0.096
5	2.000	1172.000	17.309	8.221	4.658	4.656	1.178	0.864	0.698	0.545

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_organ_system_count	0.329	-0.570
avg_length_of_stay	0.323	-0.602
rate_icu	0.323	-0.531
avg_n_imaging_lines	0.314	-0.742
avg_work_rvu	0.313	-0.447
rate_dialysis	0.281	-0.365
rate_multiple_or_days	0.273	-0.431
avg_n_j_code_lines	0.272	-0.511
avg_n_distinct_rev_codes	0.267	-0.656
rate_or	0.262	-0.451
rate_transfusion	0.250	-0.732
avg_relative_claim_charge	0.199	-0.707
rate_mechanical_ventilation	0.080	-0.530
avg_n_distinct_hcps	-0.101	-0.033

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=5 codes)

code	Description	Score	N claims	Key drivers
F13ZM6Z	EVOKED OTOACOUSTIC EMISSIONS, SCREENING ASSESSMENT USING OTOACOUSTIC EMISSION (OAE) EQUIPMENT	-2.359	1981	n distinct rev codes (-0.33), or (-0.27), relative claim charge (-0.23)
F13ZLZZ	AUDITORY EVOKED POTENTIALS ASSESSMENT	-2.530	772	n distinct rev codes (-0.38), or (-0.30), organ system count (-0.24)
F13ZL7Z	AUDITORY EVOKED POTENTIALS ASSESSMENT USING ELECTROPHYSIOLOGIC EQUIPMENT	-2.564	1882	n distinct rev codes (-0.38), n j code lines (-0.27), or (-0.25)
F13Z0ZZ	HEARING SCREENING ASSESSMENT	-2.631	2766	n distinct hcps (-0.31), n distinct rev codes (-0.30), or (-0.27)
4A03XJ1	MEASUREMENT OF ARTERIAL PULSE, PERIPHERAL, EXTERNAL APPROACH	-2.639	1431	n j code lines (-0.36), n distinct rev codes (-0.34), or (-0.31)

Tier 2 (n=5 codes)

code	Description	Score	N claims	Key drivers
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.781	3651	n j code lines (-0.11), n imaging lines (-0.10), work rvu (-0.10)
6A601ZZ	PHOTOTHERAPY OF SKIN, MULTIPLE	-1.184	1987	icu (-0.17), n imaging lines (-0.17), work rvu (-0.16)
0VTTXZZ	RESECTION OF PREPUCE, EXTERNAL APPROACH	-1.335	20223	or (+0.39), relative claim charge (-0.22), n distinct rev codes (-0.21)
6A600ZZ	PHOTOTHERAPY OF SKIN, SINGLE	-1.371	2096	work rvu (-0.19), n imaging lines (-0.18), icu (-0.18)
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-1.863	31044	n distinct rev codes (-0.26), relative claim charge (-0.22), organ system count (-0.22)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
3E0336Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.517	1033	n j code lines (+0.36), relative claim charge (+0.23), n distinct rev codes (+0.21)
06H033T	INSERTION OF INFUSION DEVICE, VIA UMBILICAL VEIN, INTO INFERIOR VENA CAVA, PERCUTANEOUS APPROACH	0.263	549	relative claim charge (+0.33), n distinct rev codes (+0.32), or (+0.23)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	0.184	1258	work rvu (+0.22), relative claim charge (+0.14), n distinct rev codes (+0.13)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	-0.049	585	relative claim charge (+0.15), n distinct rev codes (+0.14), n j code lines (+0.13)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.368	1068	n distinct rev codes (+0.20), work rvu (-0.15), relative claim charge (+0.14)

Tier 4 (n=2 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	1.703	707	relative claim charge (+0.36), mechanical ventilation (+0.33), n distinct rev codes (+0.32)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.447	738	n imaging lines (+0.50), icu (+0.24), or (+0.20)

Tier 5 (n=2 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	7.850	608	multiple or days (+1.07), work rvu (+1.02), n j code lines (+0.90)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	7.712	564	dialysis (+1.11), transfusion (+1.04), organ system count (+1.01)

Key Driver Frequency

feature	count	pct
n distinct rev codes	13	68.400
relative claim charge	9	47.400
or	8	42.100
n j code lines	6	31.600
work rvu	6	31.600
n imaging lines	4	21.100
organ system count	3	15.800
icu	3	15.800
dialysis	1	5.300
transfusion	1	5.300
mechanical ventilation	1	5.300
n distinct hcps	1	5.300
multiple or days	1	5.300