IP - ID.1.cellulitis

CM Codes

Data Overview

16086 total codes in komodo_rii; 493 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	324
CC	146
MCC	23

PCA Analysis

PC1 explains 34.9% of variance; PC1+PC2 together explain 50.8%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	work rvu	n imaging lines	icu	n j code lines
1	81.000	359807.000	12.213	4.051	0.909	5.147	0.383	0.599	0.067	0.569
2	251.000	1352796.000	13.655	5.232	1.079	5.976	0.419	0.658	0.100	0.503
3	128.000	332562.000	14.890	6.240	1.289	6.263	0.460	0.743	0.145	0.514
4	30.000	57500.000	16.774	8.003	1.623	6.245	0.589	0.911	0.237	0.633
5	3.000	2558.000	19.845	11.038	2.467	6.482	0.963	1.069	0.484	0.871

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	16	74	46	10	0	146
MCC	0	0	6	14	3	23
No CC/MCC	65	177	76	6	0	324
All	81	251	128	30	3	493

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.433	-0.135	0.387
avg_n_distinct_rev_codes	0.418	-0.094	0.261
rate_icu	0.392	-0.012	0.271
avg_length_of_stay	0.389	-0.154	0.248
rate_mechanical_ventilation	0.322	0.013	0.369
avg_n_imaging_lines	0.280	-0.160	0.216
avg_organ_system_count	0.206	-0.087	-0.285
rate_transfusion	0.206	-0.056	0.333
avg_work_rvu	0.163	-0.071	0.109
rate_multiple_or_days	0.151	0.198	0.191
rate_dialysis	0.101	0.063	0.308
avg_n_j_code_lines	0.060	-0.021	0.161
rate_or	0.000	-0.019	0.135
avg_n_distinct_hcps	-0.043	-0.109	-0.139

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=81 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K5090	Crohn's disease, unspecified, without complications	CC	-1.565	1202	n distinct rev codes (-0.41), relative claim charge (-0.37), length of stay (-0.31)
F79	Unspecified intellectual disabilities	No CC/MCC	-1.618	506	relative claim charge (-0.44), n distinct rev codes (-0.36), icu (-0.22)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-1.631	15072	relative claim charge (-0.37), length of stay (-0.35), n distinct rev codes (-0.32)
F1190	Opioid use, unspecified, uncomplicated	No CC/MCC	-1.633	1146	work rvu (+0.68), relative claim charge (-0.60), length of stay (-0.54)
E6609	Other obesity due to excess calories	No CC/MCC	-1.659	1026	relative claim charge (-0.38), icu (-0.30), n imaging lines (-0.23)
M272	Inflammatory conditions of jaws	No CC/MCC	-1.666	549	n distinct rev codes (-0.62), length of stay (-0.52), n imaging lines (+0.45)
L03112	Cellulitis of left axilla	CC	-1.689	667	n distinct rev codes (-0.41), organ system count (-0.36), multiple or days (+0.35)
E66811	Obesity, class 1	No CC/MCC	-1.697	1416	length of stay (-0.32), icu (-0.31), n distinct rev codes (-0.24)
E7849	Other hyperlipidemia	No CC/MCC	-1.714	786	icu (-0.30), relative claim charge (-0.30), n distinct rev codes (-0.24)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-1.716	22044	relative claim charge (-0.37), n distinct rev codes (-0.34), length of stay (-0.28)

Tier 2 (n=251 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5030	Unspecified diastolic (congestive) heart failure	CC	0.341	1310	icu (+0.23), length of stay (+0.22), n distinct rev codes (+0.20)
K5909	Other constipation	No CC/MCC	0.338	1103	organ system count (+0.32), icu (-0.13), n imaging lines (+0.09)
D509	Iron deficiency anemia, unspecified	No CC/MCC	0.313	12407	transfusion (+0.25), icu (-0.14), organ system count (+0.12)
I420	Dilated cardiomyopathy	CC	0.305	1248	icu (+0.40), n distinct rev codes (+0.26), n imaging lines (-0.18)
I4821	Permanent atrial fibrillation	CC	0.295	2615	icu (+0.35), n distinct rev codes (+0.24), length of stay (+0.21)
M609	Myositis, unspecified	No CC/MCC	0.278	1157	n imaging lines (+0.93), work rvu (-0.21), length of stay (-0.14)
I442	Atrioventricular block, complete	CC	0.272	691	icu (+0.22), n imaging lines (-0.17), n distinct rev codes (+0.15)
D539	Nutritional anemia, unspecified	No CC/MCC	0.249	2453	organ system count (+0.20), n distinct rev codes (+0.17), transfusion (+0.13)
K7460	Unspecified cirrhosis of liver	No CC/MCC	0.243	3828	organ system count (+0.25), icu (+0.08), length of stay (-0.08)
C787	Secondary malignant neoplasm of liver and intrahepatic bile duct	CC	0.234	821	transfusion (+0.43), icu (-0.24), n imaging lines (+0.24)

Tier 3 (n=128 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I2489	Other forms of acute ischemic heart disease	No CC/MCC	3.041	971	icu (+1.24), n distinct rev codes (+0.74), relative claim charge (+0.46)
E46	Unspecified protein-calorie malnutrition	CC	2.999	1963	length of stay (+0.81), relative claim charge (+0.47), n distinct rev codes (+0.42)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	2.868	1972	relative claim charge (+0.71), length of stay (+0.50), n distinct rev codes (+0.49)
N1330	Unspecified hydronephrosis	CC	2.850	582	n imaging lines (+0.69), relative claim charge (+0.60), n distinct rev codes (+0.48)
I5033	Acute on chronic diastolic (congestive) heart failure	MCC	2.787	7215	n distinct rev codes (+0.77), icu (+0.71), relative claim charge (+0.62)
E8770	Fluid overload, unspecified	No CC/MCC	2.779	1663	relative claim charge (+0.74), n distinct rev codes (+0.48), icu (+0.47)
B370	Candidal stomatitis	CC	2.768	868	relative claim charge (+0.69), length of stay (+0.61), n distinct rev codes (+0.35)
E662	Morbid (severe) obesity with alveolar hypoventilation	CC	2.766	2952	icu (+0.77), relative claim charge (+0.69), n distinct rev codes (+0.62)
L89313	Pressure ulcer of right buttock, stage 3	MCC	2.680	515	length of stay (+0.68), n distinct rev codes (+0.57), relative claim charge (+0.55)
N186	End stage renal disease	MCC	2.678	6225	dialysis (+1.16), relative claim charge (+0.46), icu (+0.42)

Tier 4 (n=30 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9621	Acute and chronic respiratory failure with hypoxia	MCC	8.312	2548	icu (+1.88), relative claim charge (+1.67), n distinct rev codes (+1.32)
J9601	Acute respiratory failure with hypoxia	MCC	7.511	5025	relative claim charge (+1.45), mechanical ventilation (+1.42), icu (+1.42)
D62	Acute posthemorrhagic anemia	CC	6.949	1958	transfusion (+1.98), relative claim charge (+1.31), n distinct rev codes (+1.08)
G9340	Encephalopathy, unspecified	CC	6.647	1185	n distinct rev codes (+1.05), relative claim charge (+1.05), n imaging lines (+1.04)
E8729	Other acidosis	No CC/MCC	6.564	865	icu (+1.66), relative claim charge (+1.35), mechanical ventilation (+1.08)
G928	Other toxic encephalopathy	No CC/MCC	6.392	2366	n imaging lines (+1.25), relative claim charge (+1.19), n distinct rev codes (+0.99)
G9341	Metabolic encephalopathy	MCC	6.151	5780	n imaging lines (+1.19), n distinct rev codes (+1.08), icu (+0.98)
N170	Acute kidney failure with tubular necrosis	MCC	5.550	2221	relative claim charge (+1.25), n distinct rev codes (+0.97), length of stay (+0.89)
J90	Pleural effusion, not elsewhere classified	CC	5.371	1513	relative claim charge (+1.06), n distinct rev codes (+1.05), n imaging lines (+0.73)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	5.299	513	relative claim charge (+1.38), n distinct rev codes (+0.96), icu (+0.77)

Tier 5 (n=3 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J690	Pneumonitis due to inhalation of food and vomit	MCC	15.253	814	mechanical ventilation (+3.86), relative claim charge (+2.62), length of stay (+2.00)
J9602	Acute respiratory failure with hypercapnia	MCC	15.060	605	mechanical ventilation (+4.29), icu (+2.91), relative claim charge (+2.64)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	12.302	1139	icu (+2.78), relative claim charge (+2.46), mechanical ventilation (+2.15)

Key Driver Frequency

feature	count	pct
n distinct rev codes	295	59.800
relative claim charge	293	59.400
length of stay	225	45.600
icu	204	41.400
n imaging lines	168	34.100
organ system count	138	28.000
work rvu	65	13.200
transfusion	36	7.300
multiple or days	24	4.900
mechanical ventilation	19	3.900
dialysis	9	1.800
n j code lines	3	0.600

PCS Codes

Data Overview

3347 total codes in komodo_rii; 39 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 42.7% of variance; PC1+PC2 together explain 56.9%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	transfusion	n imaging lines	or	work rvu
1	8.000	10614.000	12.256	3.641	4.446	0.920	0.014	0.466	0.304	0.228
2	17.000	13388.000	14.130	4.474	4.588	1.249	0.030	0.766	0.585	0.252
3	5.000	5672.000	14.759	6.152	5.285	1.331	0.043	0.780	0.469	0.301
4	7.000	16733.000	16.702	7.243	5.789	1.739	0.083	0.838	0.391	0.380
5	2.000	3394.000	18.974	8.023	6.036	2.004	0.625	0.921	0.292	0.377

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_length_of_stay	0.385	0.168
avg_relative_claim_charge	0.381	0.002
rate_icu	0.378	0.118
avg_n_distinct_rev_codes	0.372	-0.066
avg_organ_system_count	0.370	0.233
avg_n_imaging_lines	0.287	-0.351
rate_mechanical_ventilation	0.280	0.216
rate_transfusion	0.232	0.147
avg_work_rvu	0.174	0.322
rate_multiple_or_days	0.141	-0.010
rate_dialysis	0.118	0.115
avg_n_j_code_lines	0.008	-0.075
rate_or	-0.013	-0.451
avg_n_distinct_hcps	-0.096	-0.297

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=8 codes)

code	Description	Score	N claims	Key drivers
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-2.411	1501	relative claim charge (-0.42), length of stay (-0.38), n distinct rev codes (-0.36)
0H98XZZ	DRAINAGE OF BUTTOCK SKIN, EXTERNAL APPROACH	-2.620	718	organ system count (-0.49), relative claim charge (-0.43), length of stay (-0.41)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.820	3684	n distinct rev codes (-0.55), icu (-0.50), relative claim charge (-0.42)
0J9K0ZZ	DRAINAGE OF LEFT HAND SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-3.026	1107	n imaging lines (-0.55), icu (-0.46), length of stay (-0.37)
0J9J0ZZ	DRAINAGE OF RIGHT HAND SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-3.096	1372	n imaging lines (-0.58), icu (-0.51), relative claim charge (-0.44)
0X9J0ZZ	DRAINAGE OF RIGHT HAND, OPEN APPROACH	-3.225	537	n imaging lines (-0.52), relative claim charge (-0.52), length of stay (-0.42)
0H9GXZZ	DRAINAGE OF LEFT HAND SKIN, EXTERNAL APPROACH	-3.340	805	n imaging lines (-0.67), n distinct rev codes (-0.58), relative claim charge (-0.53)
0H9FXZZ	DRAINAGE OF RIGHT HAND SKIN, EXTERNAL APPROACH	-3.727	890	n imaging lines (-0.65), n distinct rev codes (-0.62), relative claim charge (-0.61)

Tier 2 (n=17 codes)

code	Description	Score	N claims	Key drivers
0J9Q0ZZ	DRAINAGE OF RIGHT FOOT SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.323	604	icu (-0.29), n distinct rev codes (+0.19), n imaging lines (+0.18)
0J9M0ZZ	DRAINAGE OF LEFT UPPER LEG SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.385	727	multiple or days (+0.23), organ system count (-0.17), length of stay (-0.13)
0J9L0ZZ	DRAINAGE OF RIGHT UPPER LEG SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.482	674	organ system count (-0.27), mechanical ventilation (-0.24), work rvu (+0.20)
0J9R0ZZ	DRAINAGE OF LEFT FOOT SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.594	586	icu (-0.32), work rvu (-0.27), n distinct rev codes (+0.22)
0J9P0ZZ	DRAINAGE OF LEFT LOWER LEG SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.674	829	mechanical ventilation (-0.18), work rvu (-0.18), icu (-0.17)
0J9C0ZZ	DRAINAGE OF PELVIC REGION SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.677	748	length of stay (-0.32), work rvu (+0.21), organ system count (-0.20)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-0.709	710	relative claim charge (-0.29), mechanical ventilation (-0.20), n imaging lines (-0.19)
8E0ZXY6	ISOLATION	-0.712	1410	n distinct rev codes (-0.35), work rvu (-0.22), n imaging lines (-0.14)
0J9N0ZZ	DRAINAGE OF RIGHT LOWER LEG SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.796	799	icu (-0.25), mechanical ventilation (-0.24), organ system count (-0.18)
0J980ZZ	DRAINAGE OF ABDOMEN SUBCUTANEOUS TISSUE AND FASCIA, OPEN APPROACH	-0.843	748	mechanical ventilation (-0.24), length of stay (-0.20), n imaging lines (+0.17)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	1.873	1067	multiple or days (+0.46), length of stay (+0.37), icu (+0.27)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	1.747	1193	length of stay (+0.39), mechanical ventilation (+0.27), multiple or days (+0.25)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	1.361	1897	length of stay (+0.38), icu (+0.32), organ system count (+0.23)
0W9F30Z	DRAINAGE OF ABDOMINAL WALL WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	0.881	579	n imaging lines (+0.44), multiple or days (+0.25), icu (+0.11)
HZ2ZZZZ	DETOXIFICATION SERVICES FOR SUBSTANCE ABUSE TREATMENT	0.330	936	organ system count (+0.23), mechanical ventilation (+0.23), relative claim charge (-0.22)

Tier 4 (n=7 codes)

code	Description	Score	N claims	Key drivers
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	3.833	503	relative claim charge (+0.93), length of stay (+0.86), n distinct rev codes (+0.82)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.816	5886	mechanical ventilation (+0.89), length of stay (+0.61), relative claim charge (+0.61)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	3.804	726	n distinct rev codes (+0.65), relative claim charge (+0.61), icu (+0.60)
B548ZZA	ULTRASONOGRAPHY OF SUPERIOR VENA CAVA, GUIDANCE	3.520	739	mechanical ventilation (+0.92), length of stay (+0.78), relative claim charge (+0.58)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	3.059	4261	dialysis (+0.72), organ system count (+0.68), icu (+0.65)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	2.818	3702	icu (+0.77), organ system count (+0.59), mechanical ventilation (+0.47)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	2.535	916	icu (+0.67), work rvu (+0.67), organ system count (+0.32)

Tier 5 (n=2 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	5.233	2840	transfusion (+1.32), icu (+0.66), length of stay (+0.66)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	4.969	554	n distinct rev codes (+1.11), relative claim charge (+0.99), length of stay (+0.74)

Key Driver Frequency

feature	count	pct
length of stay	22	56.400
icu	18	46.200
relative claim charge	15	38.500
organ system count	15	38.500
mechanical ventilation	12	30.800
n distinct rev codes	11	28.200
n imaging lines	11	28.200
work rvu	7	17.900
multiple or days	4	10.300
dialysis	1	2.600
transfusion	1	2.600