IP - MS.1.back_problems

CM Codes

Data Overview

14069 total codes in komodo_rii; 478 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	304
CC	153
MCC	21

PCA Analysis

PC1 explains 35.9% of variance; PC1+PC2 together explain 57.1%.

Tier Clustering (k=4)

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	icu
1	80.000	357879.000	12.862	4.797	4.749	0.950	1.262	1.336	0.498	0.097
2	241.000	882845.000	15.766	6.235	5.899	1.046	1.666	0.899	0.424	0.164
3	140.000	229456.000	17.378	6.880	5.727	1.220	1.989	0.799	0.501	0.280
4	17.000	29291.000	19.795	9.517	6.281	1.793	2.039	1.345	0.867	0.410

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	1	75	71	6	153
MCC	0	0	12	9	21
No CC/MCC	79	166	57	2	304
All	80	241	140	17	478

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.419	-0.199	0.518
avg_relative_claim_charge	0.365	-0.192	0.457
rate_icu	0.354	-0.177	0.498
rate_mechanical_ventilation	0.318	-0.114	0.550
rate_transfusion	0.314	-0.103	0.486
avg_n_imaging_lines	0.298	-0.205	0.440
avg_length_of_stay	0.296	-0.099	0.283
avg_n_distinct_hcps	0.288	-0.208	0.186
avg_organ_system_count	0.213	-0.002	-0.079
rate_multiple_or_days	0.148	0.022	0.120
avg_n_j_code_lines	0.133	-0.036	0.008
rate_dialysis	0.114	-0.032	0.380
rate_or	-0.050	0.045	-0.245
avg_work_rvu	-0.083	0.012	-0.216

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E8729	Other acidosis	No CC/MCC	5.974	4	558	icu (+0.99), relative claim charge (+0.94), mechanical ventilation (+0.93)
G928	Other toxic encephalopathy	No CC/MCC	5.011	4	2226	relative claim charge (+1.00), n distinct rev codes (+0.75), length of stay (+0.70)

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

None.

Top Codes by Tier

Tier 1 (n=80 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M50021	Cervical disc disorder at C4-C5 level with myelopathy	CC	-1.840	789	n imaging lines (-0.39), n distinct hcps (-0.31), work rvu (-0.27)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-1.906	19434	n distinct rev codes (-0.31), relative claim charge (-0.30), n distinct hcps (-0.22)
M549	Dorsalgia, unspecified	No CC/MCC	-1.960	19808	n distinct rev codes (-0.40), relative claim charge (-0.39), icu (-0.29)
M1611	Unilateral primary osteoarthritis, right hip	No CC/MCC	-1.988	939	icu (-0.40), relative claim charge (-0.34), n distinct rev codes (-0.28)
M5430	Sciatica, unspecified side	No CC/MCC	-2.021	1293	n distinct rev codes (-0.50), relative claim charge (-0.39), icu (-0.33)
M160	Bilateral primary osteoarthritis of hip	No CC/MCC	-2.039	1088	relative claim charge (-0.42), n distinct rev codes (-0.40), icu (-0.38)
M159	Polyosteoarthritis, unspecified	No CC/MCC	-2.065	600	icu (-0.41), relative claim charge (-0.39), n distinct rev codes (-0.32)
M5410	Radiculopathy, site unspecified	No CC/MCC	-2.114	1128	relative claim charge (-0.38), icu (-0.33), n distinct rev codes (-0.33)
M1612	Unilateral primary osteoarthritis, left hip	No CC/MCC	-2.170	725	n distinct rev codes (-0.47), icu (-0.42), relative claim charge (-0.29)
M48061	Spinal stenosis, lumbar region without neurogenic claudication	No CC/MCC	-2.184	37272	n distinct rev codes (-0.36), icu (-0.35), n imaging lines (-0.28)

Tier 2 (n=241 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I429	Cardiomyopathy, unspecified	CC	0.689	1641	n distinct rev codes (+0.21), n distinct hcps (+0.12), icu (+0.11)
I6523	Occlusion and stenosis of bilateral carotid arteries	No CC/MCC	0.662	797	n imaging lines (+0.38), n distinct rev codes (+0.25), icu (+0.20)
I5042	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	CC	0.627	1765	n distinct rev codes (+0.17), n distinct hcps (+0.12), n j code lines (-0.11)
K8020	Calculus of gallbladder without cholecystitis without obstruction	No CC/MCC	0.621	987	n distinct hcps (+0.30), organ system count (+0.27), n imaging lines (+0.23)
M8448XA	Pathological fracture, other site, initial encounter for fracture	CC	0.598	745	n distinct rev codes (+0.19), n imaging lines (+0.18), n distinct hcps (+0.15)
B182	Chronic viral hepatitis C	No CC/MCC	0.597	683	organ system count (+0.32), n distinct hcps (+0.17), icu (-0.11)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	0.582	1740	organ system count (+0.28), n distinct hcps (+0.21), transfusion (+0.20)
E860	Dehydration	No CC/MCC	0.577	5128	n distinct rev codes (+0.26), n distinct hcps (+0.23), n imaging lines (+0.18)
F0394	Unspecified dementia, unspecified severity, with anxiety	No CC/MCC	0.573	809	length of stay (+0.32), organ system count (+0.17), n imaging lines (+0.16)
I420	Dilated cardiomyopathy	CC	0.571	670	icu (+0.24), n j code lines (-0.19), n distinct rev codes (+0.16)

Tier 3 (n=140 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5023	Acute on chronic systolic (congestive) heart failure	MCC	4.008	581	n distinct rev codes (+0.71), icu (+0.65), relative claim charge (+0.65)
I7774	Dissection of vertebral artery	MCC	3.854	557	icu (+1.23), n imaging lines (+0.82), mechanical ventilation (+0.68)
E8339	Other disorders of phosphorus metabolism	No CC/MCC	3.756	2008	n distinct rev codes (+0.57), transfusion (+0.55), relative claim charge (+0.53)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.680	1788	dialysis (+1.26), n distinct hcps (+0.49), relative claim charge (+0.45)
K567	Ileus, unspecified	CC	3.667	965	relative claim charge (+1.18), length of stay (+0.81), transfusion (+0.65)
G8250	Quadriplegia, unspecified	MCC	3.665	567	length of stay (+1.04), relative claim charge (+0.98), mechanical ventilation (+0.76)
D6959	Other secondary thrombocytopenia	No CC/MCC	3.575	501	transfusion (+1.55), n distinct hcps (+0.44), n distinct rev codes (+0.38)
K766	Portal hypertension	CC	3.551	552	transfusion (+1.30), n distinct rev codes (+0.36), multiple or days (+0.36)
J189	Pneumonia, unspecified organism	MCC	3.542	3191	relative claim charge (+0.73), n distinct rev codes (+0.72), length of stay (+0.44)
J440	Chronic obstructive pulmonary disease with (acute) lower respiratory infection	CC	3.463	1085	n distinct rev codes (+0.79), relative claim charge (+0.71), mechanical ventilation (+0.49)

Tier 4 (n=17 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	13.171	555	mechanical ventilation (+4.30), relative claim charge (+2.45), icu (+1.90)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.783	1546	mechanical ventilation (+2.44), relative claim charge (+2.04), n distinct rev codes (+1.26)
A419	Sepsis, unspecified organism	MCC	9.516	1135	mechanical ventilation (+1.82), relative claim charge (+1.74), n distinct rev codes (+1.11)
N170	Acute kidney failure with tubular necrosis	MCC	7.764	827	relative claim charge (+1.68), transfusion (+1.48), mechanical ventilation (+1.09)
J9601	Acute respiratory failure with hypoxia	MCC	6.388	5174	mechanical ventilation (+1.59), relative claim charge (+1.13), n distinct rev codes (+0.95)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	6.291	1214	relative claim charge (+1.58), n distinct rev codes (+0.98), mechanical ventilation (+0.97)
E8729	Other acidosis	No CC/MCC	5.974	558	icu (+0.99), relative claim charge (+0.94), mechanical ventilation (+0.93)
E870	Hyperosmolality and hypernatremia	CC	5.958	1110	relative claim charge (+1.28), length of stay (+0.95), n distinct rev codes (+0.90)
D62	Acute posthemorrhagic anemia	CC	5.466	5482	transfusion (+2.86), relative claim charge (+1.10), n distinct rev codes (+0.70)
E873	Alkalosis	CC	5.106	519	relative claim charge (+1.24), mechanical ventilation (+1.01), n distinct rev codes (+0.79)

Key Driver Frequency

feature	count	pct
n distinct rev codes	240	50.200
icu	221	46.200
relative claim charge	198	41.400
n imaging lines	160	33.500
n distinct hcps	144	30.100
length of stay	125	26.200
organ system count	119	24.900
transfusion	112	23.400
mechanical ventilation	41	8.600
multiple or days	34	7.100
n j code lines	22	4.600
work rvu	10	2.100
dialysis	8	1.700

PCS Codes

Data Overview

2326 total codes in komodo_rii; 21 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 40.7% of variance; PC1+PC2 together explain 59.1%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	mechanical ventilation	n j code lines	n imaging lines	icu
1	4.000	8165.000	15.407	5.066	0.980	4.514	0.007	0.528	1.630	0.128
2	8.000	6922.000	16.515	6.506	1.228	5.131	0.013	0.468	2.003	0.223
3	5.000	7090.000	17.696	6.935	1.436	5.475	0.018	0.666	1.991	0.244
4	3.000	3951.000	19.496	9.116	1.841	5.678	0.060	0.823	1.934	0.327
5	1.000	769.000	23.096	10.412	2.949	5.703	0.853	1.327	2.398	0.812

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.409	0.060
avg_n_distinct_rev_codes	0.375	0.310
rate_icu	0.347	0.060
avg_work_rvu	0.341	0.125
rate_mechanical_ventilation	0.331	0.106
avg_length_of_stay	0.328	-0.178
avg_n_j_code_lines	0.309	-0.173
avg_organ_system_count	0.253	-0.082
rate_transfusion	0.192	0.166
avg_n_imaging_lines	0.136	0.116
rate_multiple_or_days	0.118	-0.039
rate_dialysis	0.074	-0.071
rate_or	-0.013	0.227
avg_n_distinct_hcps	-0.062	0.153

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=4 codes)

code	Description	Score	N claims	Key drivers
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-2.233	770	organ system count (-0.63), length of stay (-0.54), relative claim charge (-0.39)
3E0S33Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO EPIDURAL SPACE, PERCUTANEOUS APPROACH	-2.251	624	icu (-0.43), relative claim charge (-0.37), n distinct rev codes (-0.36)
3E0R33Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO SPINAL CANAL, PERCUTANEOUS APPROACH	-2.636	4790	n distinct rev codes (-0.42), icu (-0.40), work rvu (-0.40)
3E0R3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO SPINAL CANAL, PERCUTANEOUS APPROACH	-2.796	1981	work rvu (-0.47), relative claim charge (-0.40), n distinct rev codes (-0.39)

Tier 2 (n=8 codes)

code	Description	Score	N claims	Key drivers
0HQ1XZZ	REPAIR FACE SKIN, EXTERNAL APPROACH	-0.693	1200	length of stay (-0.34), organ system count (-0.31), icu (+0.26)
0HQ0XZZ	REPAIR SCALP SKIN, EXTERNAL APPROACH	-0.732	1560	length of stay (-0.39), organ system count (-0.28), icu (+0.24)
4A03X5D	MEASUREMENT OF ARTERIAL FLOW, INTRACRANIAL, EXTERNAL APPROACH	-0.913	820	n j code lines (-0.37), length of stay (-0.37), n imaging lines (+0.32)
F07Z9FZ	GAIT TRAINING/FUNCTIONAL AMBULATION TREATMENT USING ASSISTIVE, ADAPTIVE, SUPPORTIVE OR PROTECTIVE EQUIPMENT	-1.094	517	n distinct rev codes (-0.43), work rvu (-0.39), length of stay (+0.34)
B01B1ZZ	FLUOROSCOPY OF SPINAL CORD USING LOW OSMOLAR CONTRAST	-1.110	991	icu (-0.27), multiple or days (+0.20), n j code lines (-0.18)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-1.246	629	n distinct rev codes (-0.37), work rvu (-0.31), n j code lines (-0.21)
3E0U33Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO JOINTS, PERCUTANEOUS APPROACH	-1.299	647	icu (-0.39), n distinct rev codes (-0.32), relative claim charge (-0.22)
8E0ZXY6	ISOLATION	-1.347	558	work rvu (-0.42), n distinct rev codes (-0.39), n j code lines (-0.31)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.078	1739	work rvu (+0.47), organ system count (+0.27), length of stay (+0.17)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	0.815	2515	organ system count (+0.41), dialysis (+0.33), n j code lines (-0.18)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	0.708	642	work rvu (+0.43), n distinct rev codes (+0.24), icu (+0.14)
3E0T3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	0.150	618	n j code lines (+0.62), multiple or days (+0.29), work rvu (+0.22)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	-0.138	1576	icu (-0.20), work rvu (+0.15), n imaging lines (+0.13)

Tier 4 (n=3 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.436	1983	relative claim charge (+0.65), length of stay (+0.65), work rvu (+0.60)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.705	1384	transfusion (+0.83), n distinct rev codes (+0.55), relative claim charge (+0.37)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	1.802	584	work rvu (+0.48), n j code lines (+0.43), length of stay (+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	7.795	769	mechanical ventilation (+1.47), relative claim charge (+1.42), icu (+1.19)

Key Driver Frequency

feature	count	pct
work rvu	11	52.400
n distinct rev codes	9	42.900
icu	9	42.900
length of stay	8	38.100
n j code lines	7	33.300
relative claim charge	7	33.300
organ system count	5	23.800
n imaging lines	2	9.500
multiple or days	2	9.500
transfusion	1	4.800
mechanical ventilation	1	4.800
dialysis	1	4.800