IP - GI.1.liver_transplant

CM Codes

Data Overview

2832 total codes in komodo_rii; 36 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	17
CC	12
MCC	7

PCA Analysis

PC1 explains 40.4% of variance; PC1+PC2 together explain 58.9%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	n j code lines	n imaging lines	work rvu	organ system count	relative claim charge	mechanical ventilation
1	5.000	4054.000	11.916	27.734	2.777	0.490	1.928	6.444	0.842	0.078
2	14.000	22433.000	14.755	29.617	1.520	0.686	0.958	5.938	0.928	0.096
3	11.000	11704.000	17.768	31.036	1.749	0.932	1.133	6.049	1.003	0.119
4	4.000	3844.000	22.290	33.133	1.758	1.261	1.396	5.835	1.233	0.131
5	2.000	2378.000	24.267	34.665	1.429	1.423	1.202	5.845	1.316	0.188

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	1	5	6	0	0	12
MCC	0	0	1	4	2	7
No CC/MCC	4	9	4	0	0	17
All	5	14	11	4	2	36

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.413	-0.104	0.645
avg_n_imaging_lines	0.412	-0.084	0.649
avg_length_of_stay	0.410	-0.115	0.656
avg_relative_claim_charge	0.396	-0.090	0.684
rate_mechanical_ventilation	0.345	-0.078	0.476
rate_transfusion	0.304	-0.068	0.513
rate_icu	0.182	0.266	0.484
rate_multiple_or_days	0.115	-0.148	0.174
rate_dialysis	0.067	-0.031	0.031
rate_or	-0.062	-0.114	-0.069
avg_work_rvu	-0.066	-0.259	-0.079
avg_organ_system_count	-0.118	-0.180	-0.245
avg_n_j_code_lines	-0.133	-0.227	0.025
avg_n_distinct_hcps	-0.181	0.031	-0.488

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (0 codes)

None.

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

None.

Top Codes by Tier

Tier 1 (n=5 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	-2.616	759	n distinct rev codes (-0.58), n imaging lines (-0.47), length of stay (-0.39)
I10	Essential (primary) hypertension	No CC/MCC	-3.209	1133	n distinct rev codes (-0.57), transfusion (-0.49), n imaging lines (-0.48)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-3.481	516	length of stay (-0.61), n distinct rev codes (-0.59), n imaging lines (-0.58)
T380X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter	No CC/MCC	-3.861	573	n distinct rev codes (-0.70), n j code lines (-0.61), length of stay (-0.58)
C220	Liver cell carcinoma	CC	-3.976	1073	transfusion (-1.06), length of stay (-0.67), n distinct rev codes (-0.60)

Tier 2 (n=14 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D689	Coagulation defect, unspecified	CC	-0.270	1955	length of stay (-0.23), icu (+0.20), n imaging lines (-0.18)
D6959	Other secondary thrombocytopenia	No CC/MCC	-0.440	590	icu (-0.30), multiple or days (-0.13), dialysis (-0.13)
K766	Portal hypertension	CC	-0.478	2468	relative claim charge (-0.17), n imaging lines (-0.16), transfusion (+0.14)
N179	Acute kidney failure, unspecified	CC	-0.793	1955	n distinct rev codes (-0.16), n imaging lines (-0.15), relative claim charge (-0.14)
D62	Acute posthemorrhagic anemia	CC	-0.825	2552	n distinct rev codes (-0.28), length of stay (-0.24), n imaging lines (-0.20)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	-0.863	688	icu (-0.62), mechanical ventilation (+0.22), relative claim charge (-0.20)
K7460	Unspecified cirrhosis of liver	No CC/MCC	-0.866	961	transfusion (-0.50), relative claim charge (-0.23), mechanical ventilation (-0.22)
D696	Thrombocytopenia, unspecified	No CC/MCC	-1.258	1646	length of stay (-0.34), relative claim charge (-0.29), n imaging lines (-0.29)
K7469	Other cirrhosis of liver	No CC/MCC	-1.418	998	n distinct rev codes (-0.31), n imaging lines (-0.30), length of stay (-0.26)
I8510	Secondary esophageal varices without bleeding	CC	-1.462	1213	mechanical ventilation (-0.30), n distinct hcps (-0.29), n imaging lines (-0.25)

Tier 3 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J90	Pleural effusion, not elsewhere classified	CC	1.933	756	mechanical ventilation (+0.80), length of stay (+0.41), n imaging lines (+0.37)
D61818	Other pancytopenia	CC	1.414	543	transfusion (+0.44), n imaging lines (+0.32), length of stay (+0.31)
K7031	Alcoholic cirrhosis of liver with ascites	No CC/MCC	1.031	2088	transfusion (+0.29), n imaging lines (+0.19), n distinct rev codes (+0.18)
K7682	Hepatic encephalopathy	No CC/MCC	1.028	1095	transfusion (+0.39), mechanical ventilation (+0.33), n distinct hcps (-0.27)
I81	Portal vein thrombosis	MCC	0.963	941	relative claim charge (+0.27), mechanical ventilation (-0.19), n imaging lines (+0.15)
D849	Immunodeficiency, unspecified	CC	0.631	543	n distinct hcps (+0.42), multiple or days (+0.37), n j code lines (-0.28)
K7040	Alcoholic hepatic failure without coma	No CC/MCC	0.573	767	n imaging lines (+0.14), n j code lines (+0.09), or (+0.07)
E440	Moderate protein-calorie malnutrition	CC	0.527	793	transfusion (+0.40), dialysis (+0.12), or (-0.10)
D684	Acquired coagulation factor deficiency	CC	0.462	1039	icu (-0.44), mechanical ventilation (+0.17), transfusion (+0.15)
E871	Hypo-osmolality and hyponatremia	CC	0.277	1821	n distinct rev codes (+0.13), relative claim charge (-0.12), multiple or days (+0.10)

Tier 4 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N170	Acute kidney failure with tubular necrosis	MCC	3.716	1669	n distinct rev codes (+0.65), length of stay (+0.64), n imaging lines (+0.61)
N186	End stage renal disease	MCC	3.673	606	relative claim charge (+1.07), n distinct rev codes (+0.62), n imaging lines (+0.54)
E43	Unspecified severe protein-calorie malnutrition	MCC	3.572	1041	length of stay (+0.85), n imaging lines (+0.80), n distinct rev codes (+0.66)
K831	Obstruction of bile duct	MCC	2.197	528	n imaging lines (+0.63), length of stay (+0.59), relative claim charge (+0.48)

Tier 5 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9601	Acute respiratory failure with hypoxia	MCC	5.787	1063	mechanical ventilation (+1.29), relative claim charge (+0.99), n distinct rev codes (+0.89)
K767	Hepatorenal syndrome	MCC	5.632	1315	n distinct rev codes (+0.99), length of stay (+0.96), n imaging lines (+0.93)

Key Driver Frequency

feature	count	pct
n imaging lines	24	66.700
length of stay	17	47.200
n distinct rev codes	16	44.400
relative claim charge	12	33.300
transfusion	11	30.600
mechanical ventilation	9	25.000
icu	5	13.900
n distinct hcps	4	11.100
multiple or days	3	8.300
n j code lines	3	8.300
dialysis	2	5.600
or	2	5.600

PCS Codes

Data Overview

1601 total codes in komodo_rii; 14 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 47.6% of variance; PC1+PC2 together explain 75.5%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	n j code lines	work rvu	n imaging lines	organ system count	relative claim charge	mechanical ventilation
1	1.000	6856.000	15.724	29.885	1.827	1.175	0.822	5.423	0.994	0.096
2	4.000	2701.000	16.550	30.823	1.592	1.067	0.774	5.635	1.008	0.090
3	5.000	4186.000	16.531	30.780	1.109	0.418	0.817	5.919	0.949	0.115
4	1.000	1226.000	22.640	33.365	2.710	1.605	1.187	6.107	1.138	0.176
5	3.000	1972.000	26.376	36.471	1.396	0.990	1.535	6.119	1.253	0.200

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_imaging_lines	0.355	0.037
avg_length_of_stay	0.353	-0.037
avg_n_distinct_rev_codes	0.353	-0.279
rate_mechanical_ventilation	0.339	-0.042
avg_relative_claim_charge	0.314	-0.160
rate_multiple_or_days	0.313	0.086
avg_organ_system_count	0.310	-0.209
rate_transfusion	0.285	-0.200
rate_dialysis	0.253	-0.305
rate_or	0.197	-0.363
rate_icu	0.170	-0.534
avg_n_distinct_hcps	0.071	-0.301
avg_work_rvu	0.021	0.284
avg_n_j_code_lines	-0.009	0.560

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=1 codes)

code	Description	Score	N claims	Key drivers
0FY00Z0	TRANSPLANTATION OF LIVER, ALLOGENEIC, OPEN APPROACH	-3.921	6856	dialysis (-0.62), organ system count (-0.54), or (-0.53)

Tier 2 (n=4 codes)

code	Description	Score	N claims	Key drivers
6ABF0BZ	PERFUSION OF HEPATOBILIARY SYSTEM AND PANCREAS DONOR ORGAN, SINGLE	-1.649	618	multiple or days (-0.47), organ system count (-0.43), n imaging lines (-0.28)
0FT40ZZ	RESECTION OF GALLBLADDER, OPEN APPROACH	-1.973	782	n distinct rev codes (-0.30), mechanical ventilation (-0.29), icu (-0.23)
0WQF0ZZ	REPAIR ABDOMINAL WALL, OPEN APPROACH	-1.979	781	multiple or days (-0.37), organ system count (-0.36), n imaging lines (-0.26)
06C80ZZ	EXTIRPATION OF MATTER FROM PORTAL VEIN, OPEN APPROACH	-2.495	520	mechanical ventilation (-0.43), dialysis (-0.33), multiple or days (-0.30)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
30233R1	TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.156	684	organ system count (+0.30), transfusion (+0.26), relative claim charge (-0.21)
30233M1	TRANSFUSION OF NONAUTOLOGOUS PLASMA CRYOPRECIPITATE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.614	538	relative claim charge (-0.37), n distinct rev codes (-0.30), length of stay (-0.26)
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.657	944	relative claim charge (-0.31), n distinct rev codes (-0.25), transfusion (+0.24)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.679	1373	relative claim charge (-0.29), n distinct rev codes (-0.27), transfusion (+0.22)
0FB20ZX	EXCISION OF LEFT LOBE LIVER, OPEN APPROACH, DIAGNOSTIC	-0.830	647	transfusion (-0.46), mechanical ventilation (-0.40), dialysis (+0.40)

Tier 4 (n=1 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	1.621	1226	mechanical ventilation (+0.33), organ system count (+0.31), length of stay (+0.30)

Tier 5 (n=3 codes)

code	Description	Score	N claims	Key drivers
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	4.628	635	mechanical ventilation (+0.82), n distinct rev codes (+0.64), relative claim charge (+0.64)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	4.204	831	length of stay (+0.85), n imaging lines (+0.81), n distinct rev codes (+0.68)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	4.189	506	n distinct rev codes (+0.54), multiple or days (+0.50), mechanical ventilation (+0.48)

Key Driver Frequency

feature	count	pct
n distinct rev codes	7	50.000
mechanical ventilation	6	42.900
organ system count	5	35.700
relative claim charge	5	35.700
multiple or days	4	28.600
transfusion	4	28.600
length of stay	3	21.400
n imaging lines	3	21.400
dialysis	3	21.400
icu	1	7.100
or	1	7.100