IP - HE.1.circulatory_disorder

CM Codes

Data Overview

9813 total codes in komodo_rii; 375 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	247
CC	97
MCC	31

PCA Analysis

PC1 explains 49.8% of variance; PC1+PC2 together explain 59.9%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	organ system count	n imaging lines	work rvu	n j code lines	icu
1	243.000	1377776.000	5.151	17.023	0.998	4.876	0.625	0.481	0.449	0.382
2	108.000	470997.000	8.123	19.396	1.297	5.244	0.775	0.736	0.644	0.462
3	24.000	43769.000	10.850	22.493	1.826	5.495	1.178	0.915	0.866	0.599

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	50	37	10	97
MCC	5	14	12	31
No CC/MCC	188	57	2	247
All	243	108	24	375

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.362	-0.052	0.385
avg_n_distinct_rev_codes	0.360	-0.088	0.362
avg_length_of_stay	0.342	-0.030	0.338
rate_or	0.337	-0.042	0.316
rate_icu	0.320	0.030	0.398
rate_transfusion	0.282	-0.083	0.317
avg_n_imaging_lines	0.280	-0.216	0.239
avg_n_j_code_lines	0.257	-0.035	0.252
rate_mechanical_ventilation	0.240	0.023	0.450
avg_work_rvu	0.203	-0.083	0.234
rate_multiple_or_days	0.203	0.180	0.173
avg_organ_system_count	0.147	-0.187	-0.187
rate_dialysis	0.144	0.043	0.359
avg_n_distinct_hcps	0.001	-0.239	-0.464

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
G928	Other toxic encephalopathy	No CC/MCC	9.467	3	1186	relative claim charge (+1.41), n distinct rev codes (+1.33), n imaging lines (+1.18)
D6959	Other secondary thrombocytopenia	No CC/MCC	5.711	3	619	transfusion (+0.81), n j code lines (+0.72), or (+0.60)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	-3.582	1	2742	n distinct rev codes (-0.56), length of stay (-0.52), relative claim charge (-0.48)
I213	ST elevation (STEMI) myocardial infarction of unspecified site	MCC	-1.967	1	677	icu (+0.68), length of stay (-0.51), relative claim charge (-0.42)
I5021	Acute systolic (congestive) heart failure	MCC	-1.316	1	16953	or (-0.26), organ system count (-0.24), length of stay (-0.20)
I5041	Acute combined systolic (congestive) and diastolic (congestive) heart failure	MCC	-0.876	1	3543	organ system count (-0.20), or (-0.19), transfusion (-0.17)
I5031	Acute diastolic (congestive) heart failure	MCC	-0.854	1	3957	or (-0.18), icu (-0.16), organ system count (-0.14)

Top Codes by Tier

Tier 1 (n=243 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I352	Nonrheumatic aortic (valve) stenosis with insufficiency	No CC/MCC	0.144	1279	or (+0.65), length of stay (-0.21), n distinct rev codes (-0.14)
I69351	Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side	CC	0.142	1116	n imaging lines (+0.20), n distinct rev codes (+0.14), multiple or days (+0.11)
Q2112	Patent foramen ovale	No CC/MCC	0.103	1520	relative claim charge (+0.20), organ system count (-0.19), n j code lines (-0.16)
J849	Interstitial pulmonary disease, unspecified	CC	0.100	1482	length of stay (+0.13), n imaging lines (+0.12), n distinct rev codes (+0.09)
I083	Combined rheumatic disorders of mitral, aortic and tricuspid valves	No CC/MCC	0.086	3332	or (+0.15), n j code lines (-0.12), relative claim charge (+0.09)
J432	Centrilobular emphysema	No CC/MCC	0.067	1110	n j code lines (-0.25), n imaging lines (+0.21), n distinct rev codes (+0.19)
I890	Lymphedema, not elsewhere classified	No CC/MCC	0.033	907	length of stay (+0.30), n distinct rev codes (+0.22), n imaging lines (-0.19)
E038	Other specified hypothyroidism	No CC/MCC	-0.005	983	n j code lines (+0.36), n distinct rev codes (-0.16), length of stay (+0.12)
E8352	Hypercalcemia	No CC/MCC	-0.020	800	work rvu (+0.24), multiple or days (+0.20), transfusion (-0.14)
I4892	Unspecified atrial flutter	CC	-0.067	10019	icu (+0.16), organ system count (-0.15), n imaging lines (-0.14)

Tier 2 (n=108 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E8339	Other disorders of phosphorus metabolism	No CC/MCC	4.208	2882	length of stay (+0.60), n distinct rev codes (+0.52), or (+0.51)
I5084	End stage heart failure	No CC/MCC	4.038	2911	or (+0.84), length of stay (+0.71), multiple or days (+0.60)
D61818	Other pancytopenia	CC	3.831	1564	transfusion (+0.85), multiple or days (+0.51), length of stay (+0.49)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.810	7097	dialysis (+1.28), or (+0.63), transfusion (+0.49)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	3.805	863	mechanical ventilation (+0.81), icu (+0.59), n distinct rev codes (+0.52)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	3.779	10701	relative claim charge (+0.68), n distinct rev codes (+0.67), length of stay (+0.67)
E8729	Other acidosis	No CC/MCC	3.706	1556	icu (+0.84), n distinct rev codes (+0.68), relative claim charge (+0.61)
E46	Unspecified protein-calorie malnutrition	CC	3.595	1042	length of stay (+0.68), n distinct rev codes (+0.63), or (+0.52)
J811	Chronic pulmonary edema	CC	3.469	825	n j code lines (+0.93), work rvu (+0.91), multiple or days (+0.40)
E873	Alkalosis	CC	3.464	3753	length of stay (+0.88), relative claim charge (+0.64), n distinct rev codes (+0.57)

Tier 3 (n=24 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I469	Cardiac arrest, cause unspecified	MCC	10.223	1233	mechanical ventilation (+2.51), icu (+1.59), n imaging lines (+1.22)
J690	Pneumonitis due to inhalation of food and vomit	MCC	10.201	1573	mechanical ventilation (+1.44), relative claim charge (+1.42), n distinct rev codes (+1.22)
A419	Sepsis, unspecified organism	MCC	9.554	1881	relative claim charge (+1.59), n distinct rev codes (+1.17), icu (+1.10)
G928	Other toxic encephalopathy	No CC/MCC	9.467	1186	relative claim charge (+1.41), n distinct rev codes (+1.33), n imaging lines (+1.18)
K7200	Acute and subacute hepatic failure without coma	MCC	9.176	1635	icu (+1.45), relative claim charge (+1.39), n distinct rev codes (+1.11)
D62	Acute posthemorrhagic anemia	CC	8.879	2416	transfusion (+2.90), or (+1.39), relative claim charge (+1.30)
G9341	Metabolic encephalopathy	MCC	8.862	3053	relative claim charge (+1.13), n distinct rev codes (+1.09), n imaging lines (+0.96)
G9340	Encephalopathy, unspecified	CC	8.800	1175	n imaging lines (+1.06), relative claim charge (+1.06), n distinct rev codes (+1.02)
N170	Acute kidney failure with tubular necrosis	MCC	8.617	3425	relative claim charge (+1.33), length of stay (+1.10), n distinct rev codes (+1.01)
I462	Cardiac arrest due to underlying cardiac condition	MCC	7.900	966	mechanical ventilation (+2.08), icu (+1.40), relative claim charge (+1.10)

Key Driver Frequency

feature	count	pct
length of stay	183	48.800
n distinct rev codes	182	48.500
relative claim charge	150	40.000
icu	128	34.100
or	109	29.100
n j code lines	89	23.700
n imaging lines	72	19.200
multiple or days	68	18.100
organ system count	51	13.600
transfusion	39	10.400
work rvu	37	9.900
mechanical ventilation	9	2.400
dialysis	8	2.100

PCS Codes

Data Overview

2211 total codes in komodo_rii; 75 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 64.2% of variance; PC1+PC2 together explain 72.9%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	n j code lines	work rvu	organ system count	n imaging lines	mechanical ventilation
1	35.000	457713.000	5.252	17.288	1.077	0.474	0.451	4.257	0.590	0.014
2	21.000	82787.000	9.566	21.144	1.554	0.767	0.785	4.938	0.831	0.035
3	17.000	27947.000	12.621	23.739	2.162	1.255	1.306	5.295	1.080	0.296
4	2.000	1187.000	19.197	28.014	3.730	2.396	2.168	5.746	1.509	0.618

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.323	-0.299
avg_n_distinct_rev_codes	0.319	-0.207
avg_length_of_stay	0.316	-0.255
avg_organ_system_count	0.306	-0.229
avg_n_imaging_lines	0.304	-0.213
rate_icu	0.293	-0.139
rate_multiple_or_days	0.288	-0.216
rate_or	0.268	-0.229
avg_work_rvu	0.255	-0.281
avg_n_j_code_lines	0.254	-0.133
rate_transfusion	0.223	-0.324
rate_mechanical_ventilation	0.199	-0.142
rate_dialysis	0.195	-0.213
avg_n_distinct_hcps	0.105	-0.100

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
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	-1.294	3058	organ system count (-0.27), multiple or days (-0.19), relative claim charge (-0.11)
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-1.330	550	icu (-0.23), or (-0.23), n distinct hcps (-0.22)
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	-1.378	7770	organ system count (-0.19), multiple or days (-0.15), n j code lines (-0.14)
B31S1ZZ	FLUOROSCOPY OF RIGHT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-1.392	601	organ system count (-0.41), n imaging lines (-0.17), relative claim charge (-0.14)
4B02XTZ	MEASUREMENT OF CARDIAC DEFIBRILLATOR, EXTERNAL APPROACH	-1.407	880	icu (-0.21), relative claim charge (-0.21), n distinct rev codes (-0.16)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	-1.756	9342	organ system count (-0.30), n imaging lines (-0.22), multiple or days (-0.18)
B4101ZZ	FLUOROSCOPY OF ABDOMINAL AORTA USING LOW OSMOLAR CONTRAST	-1.806	614	icu (-0.27), length of stay (-0.26), work rvu (-0.19)
8E0ZXY6	ISOLATION	-1.866	836	multiple or days (-0.28), n distinct rev codes (-0.20), work rvu (-0.18)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-1.920	4092	n distinct rev codes (-0.28), icu (-0.26), relative claim charge (-0.23)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-2.109	1459	organ system count (-0.35), n distinct rev codes (-0.28), relative claim charge (-0.25)

Tier 2 (n=21 codes)

code	Description	Score	N claims	Key drivers
0DJD8ZZ	INSPECTION OF LOWER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.773	770	n distinct rev codes (+0.37), transfusion (+0.37), length of stay (+0.30)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	1.724	2790	or (+0.55), n distinct rev codes (+0.37), n imaging lines (+0.32)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	1.719	811	work rvu (+0.49), n j code lines (+0.36), or (+0.31)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.701	1094	transfusion (+0.43), organ system count (+0.39), n distinct rev codes (+0.35)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	1.519	1584	or (+0.54), n distinct rev codes (+0.37), multiple or days (+0.27)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	1.420	1343	icu (+0.40), n distinct rev codes (+0.26), length of stay (+0.23)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	1.137	6770	dialysis (+1.04), organ system count (+0.34), n j code lines (-0.10)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.865	1193	organ system count (+0.33), n distinct rev codes (+0.30), n imaging lines (+0.25)
02HQ32Z	INSERTION OF MONITORING DEVICE INTO RIGHT PULMONARY ARTERY, PERCUTANEOUS APPROACH	0.747	2219	icu (+0.28), n j code lines (+0.24), length of stay (+0.19)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.710	551	organ system count (+0.31), transfusion (+0.28), n distinct rev codes (+0.28)

Tier 3 (n=17 codes)

code	Description	Score	N claims	Key drivers
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	5.515	2241	n imaging lines (+0.77), mechanical ventilation (+0.72), icu (+0.61)
4A133J1	MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH	4.562	621	work rvu (+0.83), n j code lines (+0.66), organ system count (+0.50)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	4.501	1243	multiple or days (+0.74), organ system count (+0.50), icu (+0.49)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	4.346	1172	or (+0.66), length of stay (+0.64), relative claim charge (+0.52)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	4.324	1971	or (+0.78), length of stay (+0.67), dialysis (+0.52)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	4.225	1392	mechanical ventilation (+0.81), n imaging lines (+0.73), icu (+0.61)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	4.135	842	work rvu (+0.65), n j code lines (+0.49), icu (+0.46)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	3.936	2156	icu (+0.51), relative claim charge (+0.46), multiple or days (+0.43)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.442	7101	or (+0.48), length of stay (+0.43), multiple or days (+0.40)
05HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	3.335	537	multiple or days (+0.61), relative claim charge (+0.45), length of stay (+0.41)

Tier 4 (n=2 codes)

code	Description	Score	N claims	Key drivers
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	9.772	517	n j code lines (+1.18), relative claim charge (+1.09), work rvu (+1.06)
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	8.368	670	relative claim charge (+1.33), n imaging lines (+1.10), mechanical ventilation (+0.81)

Key Driver Frequency

feature	count	pct
n distinct rev codes	32	42.700
length of stay	32	42.700
organ system count	31	41.300
icu	25	33.300
n imaging lines	21	28.000
multiple or days	19	25.300
relative claim charge	17	22.700
or	13	17.300
work rvu	12	16.000
n j code lines	10	13.300
transfusion	4	5.300
mechanical ventilation	4	5.300
n distinct hcps	3	4.000
dialysis	2	2.700