IP - GI.1.digestive_disorder

CM Codes

Data Overview

14224 total codes in komodo_rii; 458 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	313
CC	123
MCC	22

PCA Analysis

PC1 explains 36.6% of variance; PC1+PC2 together explain 51.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	work rvu	n j code lines	organ system count	n imaging lines	icu
1	239.000	2312180.000	13.372	4.308	1.024	0.502	0.575	5.308	0.925	0.124
2	188.000	748968.000	14.801	5.198	1.232	0.650	0.680	5.424	0.979	0.168
3	31.000	90662.000	16.588	6.953	1.657	1.045	1.065	5.634	1.073	0.236

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	37	73	13	123
MCC	1	10	11	22
No CC/MCC	201	105	7	313
All	239	188	31	458

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.402	-0.124	0.394
avg_n_distinct_rev_codes	0.380	0.006	0.309
avg_length_of_stay	0.346	-0.120	0.403
rate_icu	0.304	0.058	0.305
rate_mechanical_ventilation	0.302	-0.088	0.414
rate_multiple_or_days	0.272	-0.012	0.171
avg_work_rvu	0.271	-0.177	0.119
avg_n_j_code_lines	0.242	-0.152	0.157
rate_transfusion	0.239	0.021	0.395
rate_or	0.209	-0.122	0.175
avg_n_imaging_lines	0.185	-0.002	0.192
avg_n_distinct_hcps	0.151	-0.102	-0.095
avg_organ_system_count	0.138	0.011	-0.087
rate_dialysis	0.082	0.127	0.267

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	8.656	3	2303	mechanical ventilation (+1.49), relative claim charge (+1.37), n distinct rev codes (+1.19)
E8770	Fluid overload, unspecified	No CC/MCC	5.965	3	1272	relative claim charge (+0.82), length of stay (+0.73), n distinct rev codes (+0.63)
M6281	Muscle weakness (generalized)	No CC/MCC	5.903	3	1032	length of stay (+3.11), n distinct rev codes (+1.40), work rvu (+0.69)
Q2112	Patent foramen ovale	No CC/MCC	5.626	3	1093	relative claim charge (+2.18), n j code lines (+1.98), mechanical ventilation (+1.56)
B952	Enterococcus as the cause of diseases classified elsewhere	No CC/MCC	3.972	3	1282	relative claim charge (+1.28), length of stay (+0.95), n distinct rev codes (+0.56)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K8590	Acute pancreatitis without necrosis or infection, unspecified	MCC	-0.876	1	3698	n j code lines (+0.29), length of stay (-0.26), relative claim charge (-0.22)

Top Codes by Tier

Tier 1 (n=239 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I110	Hypertensive heart disease with heart failure	No CC/MCC	-0.264	20934	n distinct rev codes (+0.20), icu (+0.18), work rvu (-0.14)
N1330	Unspecified hydronephrosis	CC	-0.267	3167	icu (-0.18), mechanical ventilation (-0.14), n imaging lines (+0.12)
N1832	Chronic kidney disease, stage 3b	No CC/MCC	-0.277	6453	or (-0.17), relative claim charge (-0.16), organ system count (+0.15)
M47816	Spondylosis without myelopathy or radiculopathy, lumbar region	No CC/MCC	-0.287	940	work rvu (+0.31), n distinct rev codes (-0.26), n imaging lines (+0.23)
N390	Urinary tract infection, site not specified	CC	-0.295	24567	length of stay (+0.14), work rvu (-0.13), multiple or days (-0.12)
N3001	Acute cystitis with hematuria	CC	-0.297	1169	n distinct hcps (-0.30), n distinct rev codes (+0.17), icu (-0.17)
N179	Acute kidney failure, unspecified	CC	-0.315	59957	icu (+0.15), n distinct hcps (-0.12), work rvu (-0.11)
J849	Interstitial pulmonary disease, unspecified	CC	-0.318	1241	multiple or days (-0.32), organ system count (+0.14), work rvu (-0.13)
G20	None	No CC/MCC	-0.322	1503	multiple or days (-0.32), n distinct hcps (+0.31), n j code lines (-0.29)
F331	Major depressive disorder, recurrent, moderate	CC	-0.357	1950	n distinct hcps (-0.24), length of stay (+0.21), icu (-0.17)

Tier 2 (n=188 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E870	Hyperosmolality and hypernatremia	CC	3.284	5704	length of stay (+0.82), relative claim charge (+0.82), n distinct rev codes (+0.56)
K5981	Ogilvie syndrome	No CC/MCC	3.093	2290	length of stay (+1.02), relative claim charge (+0.92), icu (+0.54)
D61810	Antineoplastic chemotherapy induced pancytopenia	MCC	3.072	2699	transfusion (+1.81), relative claim charge (+0.66), length of stay (+0.48)
J9610	Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	CC	3.045	1505	mechanical ventilation (+2.29), icu (+0.37), relative claim charge (+0.24)
D500	Iron deficiency anemia secondary to blood loss (chronic)	No CC/MCC	2.946	2315	transfusion (+1.24), multiple or days (+0.65), n distinct rev codes (+0.33)
I4710	Supraventricular tachycardia, unspecified	No CC/MCC	2.937	1776	n j code lines (+0.57), icu (+0.54), work rvu (+0.43)
J984	Other disorders of lung	No CC/MCC	2.865	942	work rvu (+0.82), multiple or days (+0.57), n j code lines (+0.48)
E662	Morbid (severe) obesity with alveolar hypoventilation	CC	2.859	870	n distinct rev codes (+0.50), length of stay (+0.45), icu (+0.41)
A0472	Enterocolitis due to Clostridium difficile, not specified as recurrent	CC	2.839	2257	length of stay (+0.77), relative claim charge (+0.68), work rvu (+0.37)
K7031	Alcoholic cirrhosis of liver with ascites	No CC/MCC	2.811	1112	transfusion (+0.66), or (+0.45), multiple or days (+0.40)

Tier 3 (n=31 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9621	Acute and chronic respiratory failure with hypoxia	MCC	11.549	2158	mechanical ventilation (+2.45), relative claim charge (+1.98), icu (+1.40)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.899	4885	mechanical ventilation (+2.02), relative claim charge (+1.63), n distinct rev codes (+1.31)
J9601	Acute respiratory failure with hypoxia	MCC	9.858	7769	mechanical ventilation (+2.17), relative claim charge (+1.51), n distinct rev codes (+1.26)
A419	Sepsis, unspecified organism	MCC	8.988	4847	mechanical ventilation (+1.55), work rvu (+1.21), relative claim charge (+1.19)
G928	Other toxic encephalopathy	No CC/MCC	8.656	2303	mechanical ventilation (+1.49), relative claim charge (+1.37), n distinct rev codes (+1.19)
G9340	Encephalopathy, unspecified	CC	7.584	1808	length of stay (+1.10), n distinct rev codes (+1.05), work rvu (+1.04)
I5033	Acute on chronic diastolic (congestive) heart failure	MCC	6.783	2419	relative claim charge (+1.14), multiple or days (+1.13), n distinct rev codes (+1.11)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	6.626	1310	relative claim charge (+1.28), n distinct rev codes (+0.84), length of stay (+0.82)
F05	Delirium due to known physiological condition	CC	6.598	2302	length of stay (+1.11), relative claim charge (+0.87), n distinct rev codes (+0.86)
E874	Mixed disorder of acid-base balance	CC	6.562	1184	multiple or days (+1.22), mechanical ventilation (+1.18), relative claim charge (+0.94)

Key Driver Frequency

feature	count	pct
n distinct rev codes	252	55.000
relative claim charge	245	53.500
length of stay	158	34.500
icu	145	31.700
multiple or days	120	26.200
work rvu	110	24.000
n j code lines	83	18.100
or	51	11.100
transfusion	51	11.100
n imaging lines	43	9.400
n distinct hcps	42	9.200
organ system count	37	8.100
mechanical ventilation	31	6.800
dialysis	6	1.300

PCS Codes

Data Overview

2988 total codes in komodo_rii; 58 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 37.0% of variance; PC1+PC2 together explain 53.7%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	n j code lines	work rvu	mechanical ventilation	organ system count	icu
1	7.000	12425.000	11.832	3.269	1.190	0.469	0.101	0.013	4.057	0.078
2	31.000	152064.000	16.183	5.141	1.450	0.595	0.392	0.005	4.642	0.149
3	14.000	25366.000	16.450	6.678	1.764	0.861	0.579	0.017	4.727	0.161
4	5.000	18021.000	17.266	7.675	2.081	1.333	0.904	0.033	4.793	0.218
5	1.000	1095.000	21.830	8.909	4.595	1.870	1.591	0.791	4.791	0.571

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_work_rvu	0.379	-0.084
avg_n_distinct_rev_codes	0.340	0.181
rate_icu	0.338	-0.070
avg_relative_claim_charge	0.333	-0.246
avg_length_of_stay	0.325	-0.007
avg_n_j_code_lines	0.308	-0.019
rate_mechanical_ventilation	0.302	-0.156
rate_multiple_or_days	0.302	0.040
rate_transfusion	0.231	0.165
rate_or	0.180	0.082
avg_n_imaging_lines	0.159	-0.020
avg_organ_system_count	0.139	-0.043
rate_dialysis	0.038	0.150
avg_n_distinct_hcps	0.027	-0.036

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=7 codes)

code	Description	Score	N claims	Key drivers
8E0ZXY6	ISOLATION	-2.830	2834	n distinct rev codes (-0.62), multiple or days (-0.47), work rvu (-0.42)
BW211ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF ABDOMEN AND PELVIS USING LOW OSMOLAR CONTRAST	-3.205	1622	n distinct rev codes (-0.79), work rvu (-0.52), multiple or days (-0.47)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.396	2606	n distinct rev codes (-0.74), multiple or days (-0.47), work rvu (-0.46)
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-3.459	831	length of stay (-0.85), organ system count (-0.74), n imaging lines (-0.53)
3E013GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO SUBCUTANEOUS TISSUE, PERCUTANEOUS APPROACH	-3.754	892	n distinct rev codes (-0.77), work rvu (-0.51), multiple or days (-0.47)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.825	1883	n distinct rev codes (-0.80), work rvu (-0.52), length of stay (-0.48)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-4.196	1757	n distinct rev codes (-0.77), icu (-0.54), work rvu (-0.53)

Tier 2 (n=31 codes)

code	Description	Score	N claims	Key drivers
0DBL8ZX	EXCISION OF TRANSVERSE COLON, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.142	3569	multiple or days (+0.35), icu (-0.14), n distinct rev codes (+0.13)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	0.027	1242	work rvu (+0.34), icu (+0.32), multiple or days (-0.28)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.090	7077	organ system count (+0.30), dialysis (+0.28), icu (+0.27)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-0.090	12458	n j code lines (-0.12), relative claim charge (-0.11), organ system count (+0.06)
0DBP8ZX	EXCISION OF RECTUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.117	3735	icu (-0.19), n distinct rev codes (+0.12), relative claim charge (-0.08)
0W9G30Z	DRAINAGE OF PERITONEAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-0.151	2755	or (+0.35), n distinct rev codes (-0.20), icu (-0.19)
0DBN8ZX	EXCISION OF SIGMOID COLON, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.168	5363	multiple or days (+0.20), icu (-0.14), n distinct rev codes (+0.12)
0DBM8ZX	EXCISION OF DESCENDING COLON, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.244	3265	icu (-0.17), multiple or days (+0.14), relative claim charge (-0.12)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.285	1910	icu (+0.68), length of stay (-0.28), or (-0.23)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.314	12946	n distinct rev codes (+0.22), length of stay (-0.17), relative claim charge (-0.16)

Tier 3 (n=14 codes)

code	Description	Score	N claims	Key drivers
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	2.053	1820	work rvu (+0.45), or (+0.36), multiple or days (+0.35)
3E0336Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.637	1815	relative claim charge (+0.79), length of stay (+0.63), n j code lines (+0.18)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	1.496	3332	length of stay (+0.76), n distinct rev codes (+0.32), or (+0.20)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	1.151	1149	n j code lines (+0.56), length of stay (+0.36), work rvu (+0.31)
0DBK8ZZ	EXCISION OF ASCENDING COLON, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.142	855	multiple or days (+0.86), n distinct rev codes (+0.28), organ system count (+0.17)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	1.079	3792	length of stay (+0.48), work rvu (+0.38), n j code lines (+0.27)
0DBL8ZZ	EXCISION OF TRANSVERSE COLON, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.935	917	multiple or days (+0.76), n distinct rev codes (+0.26), n j code lines (-0.20)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	0.839	1146	multiple or days (+0.33), length of stay (+0.26), or (+0.17)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	0.748	1822	length of stay (+0.23), or (+0.18), n imaging lines (+0.15)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	0.725	2923	icu (+0.34), work rvu (+0.33), multiple or days (-0.26)

Tier 4 (n=5 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.746	6951	length of stay (+0.70), multiple or days (+0.47), n j code lines (+0.42)
0CJS8ZZ	INSPECTION OF LARYNX, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.637	1065	n j code lines (+1.63), work rvu (+1.47), multiple or days (+0.43)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.511	6321	transfusion (+1.50), icu (+0.48), work rvu (+0.32)
0W3P8ZZ	CONTROL BLEEDING IN GASTROINTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.237	1399	work rvu (+0.73), multiple or days (+0.60), transfusion (+0.60)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	2.229	2285	length of stay (+1.06), relative claim charge (+0.69), n j code lines (+0.32)

Tier 5 (n=1 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	11.232	1095	mechanical ventilation (+2.25), relative claim charge (+1.76), icu (+1.75)

Key Driver Frequency

feature	count	pct
n distinct rev codes	29	50.000
multiple or days	26	44.800
work rvu	26	44.800
icu	20	34.500
n j code lines	17	29.300
length of stay	17	29.300
relative claim charge	16	27.600
or	10	17.200
n imaging lines	4	6.900
organ system count	4	6.900
transfusion	3	5.200
dialysis	1	1.700
mechanical ventilation	1	1.700