IP - HE.1.RBC_disorder

CM Codes

Data Overview

13857 total codes in komodo_rii; 454 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	307
CC	106
MCC	41

PCA Analysis

PC1 explains 38.5% of variance; PC1+PC2 together explain 55.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	n imaging lines	work rvu	n j code lines	transfusion
1	113.000	489426.000	13.417	5.154	4.742	0.983	0.440	0.506	0.571	0.527
2	299.000	1157852.000	16.464	5.555	5.777	1.154	0.675	0.602	0.500	0.750
3	42.000	62357.000	18.642	8.234	6.066	1.681	0.864	0.856	0.835	0.767

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	17	75	14	106
MCC	6	21	14	41
No CC/MCC	90	203	14	307
All	113	299	42	454

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.403	-0.095	0.245
rate_icu	0.371	0.031	0.373
avg_n_imaging_lines	0.348	-0.129	0.242
avg_relative_claim_charge	0.347	-0.116	0.352
avg_organ_system_count	0.287	-0.066	-0.169
rate_transfusion	0.280	0.087	0.284
rate_mechanical_ventilation	0.270	0.049	0.398
avg_length_of_stay	0.261	-0.146	0.232
rate_multiple_or_days	0.227	-0.039	0.159
rate_or	0.193	-0.134	-0.008
avg_n_distinct_hcps	0.188	-0.029	-0.209
rate_dialysis	0.124	0.053	0.287
avg_work_rvu	0.107	-0.186	-0.013
avg_n_j_code_lines	0.077	-0.087	0.112

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	7.862	3	1242	n imaging lines (+1.69), relative claim charge (+1.29), mechanical ventilation (+1.19)
E8729	Other acidosis	No CC/MCC	4.236	3	860	icu (+0.90), relative claim charge (+0.76), n distinct rev codes (+0.66)
M6281	Muscle weakness (generalized)	No CC/MCC	3.886	3	1213	length of stay (+1.94), n distinct rev codes (+1.10), or (+0.58)
B952	Enterococcus as the cause of diseases classified elsewhere	No CC/MCC	3.704	3	570	multiple or days (+0.66), length of stay (+0.49), n distinct rev codes (+0.48)
M48062	Spinal stenosis, lumbar region with neurogenic claudication	No CC/MCC	3.306	3	548	or (+1.52), relative claim charge (+1.49), transfusion (-0.70)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D57219	Sickle-cell/Hb-C disease with crisis, unspecified	MCC	-5.294	1	5700	transfusion (-1.02), n distinct rev codes (-1.01), icu (-0.74)
D5702	Hb-SS disease with splenic sequestration	MCC	-5.151	1	733	organ system count (-1.13), n imaging lines (-0.92), n distinct rev codes (-0.90)
D5700	Hb-SS disease with crisis, unspecified	MCC	-4.589	1	60045	n distinct rev codes (-0.82), icu (-0.67), n imaging lines (-0.58)
D57419	Sickle-cell thalassemia, unspecified, with crisis	MCC	-4.375	1	2130	n distinct rev codes (-0.81), transfusion (-0.78), icu (-0.66)
D57211	Sickle-cell/Hb-C disease with acute chest syndrome	MCC	-3.279	1	795	organ system count (-0.66), transfusion (-0.55), n distinct rev codes (-0.52)

Top Codes by Tier

Tier 1 (n=113 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D589	Hereditary hemolytic anemia, unspecified	CC	-1.239	1276	organ system count (-0.41), multiple or days (-0.24), length of stay (-0.19)
I2782	Chronic pulmonary embolism	CC	-1.239	644	n distinct rev codes (-0.35), transfusion (-0.32), n distinct hcps (-0.27)
D6869	Other thrombophilia	CC	-1.249	1119	n distinct hcps (-0.23), n distinct rev codes (-0.19), work rvu (-0.16)
M1712	Unilateral primary osteoarthritis, left knee	No CC/MCC	-1.277	666	or (+0.93), icu (-0.65), transfusion (-0.61)
F339	Major depressive disorder, recurrent, unspecified	CC	-1.278	996	icu (-0.44), n distinct rev codes (-0.37), n distinct hcps (+0.25)
D7589	Other specified diseases of blood and blood-forming organs	No CC/MCC	-1.279	921	multiple or days (-0.24), icu (-0.18), relative claim charge (-0.17)
I10	Essential (primary) hypertension	No CC/MCC	-1.307	53575	relative claim charge (-0.23), n distinct rev codes (-0.20), length of stay (-0.19)
J309	Allergic rhinitis, unspecified	No CC/MCC	-1.342	559	icu (-0.42), transfusion (-0.36), n imaging lines (-0.35)
F1090	Alcohol use, unspecified, uncomplicated	No CC/MCC	-1.362	735	relative claim charge (-0.35), length of stay (-0.28), multiple or days (-0.24)
D6851	Activated protein C resistance	CC	-1.365	503	n distinct rev codes (-0.31), n distinct hcps (-0.29), icu (-0.18)

Tier 2 (n=299 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D689	Coagulation defect, unspecified	CC	2.359	2678	icu (+0.71), n distinct rev codes (+0.40), relative claim charge (+0.34)
B3781	Candidal esophagitis	CC	2.259	782	n distinct rev codes (+0.58), multiple or days (+0.51), transfusion (+0.28)
J9612	Chronic respiratory failure with hypercapnia	CC	2.218	603	mechanical ventilation (+0.72), icu (+0.42), n distinct rev codes (+0.39)
I2729	Other secondary pulmonary hypertension	No CC/MCC	2.215	675	multiple or days (+0.85), length of stay (+0.45), relative claim charge (+0.36)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	2.187	1403	n distinct rev codes (+0.42), n imaging lines (+0.28), multiple or days (+0.27)
B961	Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere	No CC/MCC	2.148	891	organ system count (+0.40), n distinct rev codes (+0.36), relative claim charge (+0.33)
N319	Neuromuscular dysfunction of bladder, unspecified	No CC/MCC	2.132	534	length of stay (+0.63), multiple or days (+0.53), organ system count (+0.50)
N136	Pyonephrosis	CC	2.112	713	n imaging lines (+0.78), n distinct rev codes (+0.44), length of stay (+0.25)
I5021	Acute systolic (congestive) heart failure	MCC	2.105	541	relative claim charge (+0.72), icu (+0.61), n distinct rev codes (+0.53)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	2.105	1988	icu (+0.57), n distinct rev codes (+0.48), relative claim charge (+0.30)

Tier 3 (n=42 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	12.347	510	mechanical ventilation (+3.43), relative claim charge (+2.02), icu (+1.97)
J690	Pneumonitis due to inhalation of food and vomit	MCC	8.545	1211	mechanical ventilation (+1.81), relative claim charge (+1.49), n distinct rev codes (+1.14)
G928	Other toxic encephalopathy	No CC/MCC	7.862	1242	n imaging lines (+1.69), relative claim charge (+1.29), mechanical ventilation (+1.19)
A419	Sepsis, unspecified organism	MCC	7.859	2449	mechanical ventilation (+1.20), relative claim charge (+1.17), n imaging lines (+0.93)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	7.540	833	relative claim charge (+1.53), icu (+1.47), mechanical ventilation (+1.43)
G9340	Encephalopathy, unspecified	CC	6.838	1274	n imaging lines (+1.37), relative claim charge (+0.89), mechanical ventilation (+0.82)
N170	Acute kidney failure with tubular necrosis	MCC	6.227	1959	relative claim charge (+1.26), icu (+0.95), n distinct rev codes (+0.82)
G9341	Metabolic encephalopathy	MCC	5.739	3574	n imaging lines (+1.36), n distinct rev codes (+0.90), icu (+0.86)
K567	Ileus, unspecified	CC	4.941	650	relative claim charge (+1.01), length of stay (+0.81), n distinct rev codes (+0.73)
J918	Pleural effusion in other conditions classified elsewhere	CC	4.809	646	relative claim charge (+0.82), n distinct rev codes (+0.82), length of stay (+0.59)

Key Driver Frequency

feature	count	pct
n distinct rev codes	255	56.200
icu	202	44.500
relative claim charge	152	33.500
transfusion	151	33.300
organ system count	133	29.300
n imaging lines	127	28.000
length of stay	110	24.200
multiple or days	96	21.100
n distinct hcps	57	12.600
or	25	5.500
mechanical ventilation	20	4.400
work rvu	16	3.500
dialysis	12	2.600
n j code lines	6	1.300

PCS Codes

Data Overview

2603 total codes in komodo_rii; 58 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 52.0% of variance; PC1+PC2 together explain 67.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	work rvu	n imaging lines	transfusion	n j code lines
1	14.000	15220.000	10.577	3.439	2.178	0.878	0.238	0.140	0.167	0.921
2	39.000	187792.000	18.005	5.657	5.169	1.436	0.456	0.737	0.819	0.511
3	5.000	6029.000	22.000	10.885	5.616	3.099	1.314	1.047	0.817	1.199

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.347	0.007
rate_icu	0.338	0.033
avg_n_imaging_lines	0.335	0.012
avg_length_of_stay	0.333	-0.167
avg_relative_claim_charge	0.329	-0.114
avg_organ_system_count	0.308	0.090
rate_transfusion	0.294	0.451
rate_multiple_or_days	0.271	0.138
avg_work_rvu	0.253	-0.063
rate_or	0.230	0.072
rate_dialysis	0.188	0.122
rate_mechanical_ventilation	0.161	-0.192
avg_n_j_code_lines	-0.002	-0.291
avg_n_distinct_hcps	-0.031	-0.023

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=14 codes)

code	Description	Score	N claims	Key drivers
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.139	861	icu (-0.36), n distinct rev codes (-0.33), work rvu (-0.30)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-2.229	792	n distinct rev codes (-0.47), transfusion (-0.32), organ system count (-0.28)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.016	763	n distinct rev codes (-0.45), icu (-0.43), or (-0.35)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.251	1174	n distinct rev codes (-0.54), icu (-0.39), transfusion (-0.36)
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-3.323	680	organ system count (-0.52), length of stay (-0.49), transfusion (-0.45)
3E0P7VZ	INTRODUCTION OF HORMONE INTO FEMALE REPRODUCTIVE, VIA NATURAL OR ARTIFICIAL OPENING	-3.813	761	organ system count (-0.65), n imaging lines (-0.61), transfusion (-0.56)
10H07YZ	INSERTION OF OTHER DEVICE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-3.836	665	organ system count (-0.65), n imaging lines (-0.62), transfusion (-0.56)
3E0DXGC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO MOUTH AND PHARYNX, EXTERNAL APPROACH	-4.047	629	organ system count (-0.64), n imaging lines (-0.60), transfusion (-0.55)
10E0XZZ	DELIVERY OF PRODUCTS OF CONCEPTION, EXTERNAL APPROACH	-4.226	743	n distinct rev codes (-0.64), n imaging lines (-0.63), organ system count (-0.63)
3E033VJ	INTRODUCTION OF OTHER HORMONE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-4.313	2216	organ system count (-0.66), n imaging lines (-0.62), n distinct rev codes (-0.61)

Tier 2 (n=39 codes)

code	Description	Score	N claims	Key drivers
079T3ZX	DRAINAGE OF BONE MARROW, PERCUTANEOUS APPROACH, DIAGNOSTIC	2.760	1038	n imaging lines (+0.68), or (+0.49), n distinct rev codes (+0.36)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	2.520	515	icu (+0.86), relative claim charge (+0.45), length of stay (+0.41)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	2.502	1271	multiple or days (+0.60), or (+0.56), n distinct rev codes (+0.26)
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.390	850	icu (+0.62), multiple or days (+0.57), n imaging lines (+0.30)
07DR3ZX	EXTRACTION OF ILIAC BONE MARROW, PERCUTANEOUS APPROACH, DIAGNOSTIC	2.332	2517	n imaging lines (+0.67), or (+0.48), n distinct rev codes (+0.37)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	1.816	590	n distinct rev codes (+0.38), relative claim charge (+0.35), icu (+0.34)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	1.744	5817	dialysis (+1.08), organ system count (+0.24), work rvu (+0.21)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	1.147	527	length of stay (+0.33), or (+0.25), n imaging lines (+0.20)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.139	2466	icu (+0.35), organ system count (+0.23), length of stay (+0.20)
30233R1	TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.139	1751	icu (+0.31), transfusion (+0.26), n imaging lines (+0.24)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	7.078	591	length of stay (+1.24), relative claim charge (+1.12), multiple or days (+0.94)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	6.871	815	relative claim charge (+1.30), mechanical ventilation (+1.20), icu (+1.04)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	5.560	704	length of stay (+0.91), relative claim charge (+0.87), multiple or days (+0.72)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	4.517	3293	length of stay (+0.70), relative claim charge (+0.59), multiple or days (+0.55)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	3.897	626	work rvu (+0.93), n imaging lines (+0.54), n distinct rev codes (+0.49)

Key Driver Frequency

feature	count	pct
n distinct rev codes	34	58.600
transfusion	30	51.700
organ system count	28	48.300
n imaging lines	18	31.000
length of stay	13	22.400
multiple or days	11	19.000
work rvu	11	19.000
or	10	17.200
icu	9	15.500
relative claim charge	8	13.800
dialysis	1	1.700
mechanical ventilation	1	1.700