IP - NU.1.degenerative

CM Codes

Data Overview

13848 total codes in komodo_rii; 468 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	340
CC	94
MCC	34

PCA Analysis

PC1 explains 39.8% of variance; PC1+PC2 together explain 54.2%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	n imaging lines	n j code lines	work rvu	icu
1	96.000	459644.000	12.518	14.938	1.052	5.022	0.443	0.195	0.385	0.041
2	213.000	1028250.000	14.198	12.821	1.019	5.638	0.783	0.256	0.505	0.105
3	111.000	265989.000	15.445	12.112	1.090	5.633	1.021	0.359	0.617	0.161
4	36.000	77314.000	16.438	12.306	1.222	5.573	1.108	0.532	0.705	0.232
5	12.000	23950.000	18.701	12.265	1.775	5.806	1.125	0.721	0.942	0.497

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	15	24	38	15	2	94
MCC	0	9	11	7	7	34
No CC/MCC	81	180	62	14	3	340
All	96	213	111	36	12	468

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
rate_icu	0.382	-0.096	0.301
avg_n_distinct_rev_codes	0.356	-0.113	0.393
rate_or	0.340	-0.153	0.264
rate_mechanical_ventilation	0.334	-0.049	0.380
rate_transfusion	0.313	-0.027	0.368
avg_n_j_code_lines	0.312	-0.005	0.280
avg_relative_claim_charge	0.277	-0.049	0.350
rate_multiple_or_days	0.265	0.197	0.222
avg_n_imaging_lines	0.260	-0.093	0.176
avg_work_rvu	0.198	-0.074	0.241
avg_n_distinct_hcps	0.150	-0.143	-0.091
avg_organ_system_count	0.111	-0.087	-0.223
rate_dialysis	0.044	-0.006	0.297
avg_length_of_stay	-0.119	0.003	0.109

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E8729	Other acidosis	No CC/MCC	9.457	5	815	icu (+1.72), mechanical ventilation (+1.20), multiple or days (+1.11)
T380X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter	No CC/MCC	8.160	5	766	n j code lines (+1.29), transfusion (+1.25), icu (+1.15)
G40901	Epilepsy, unspecified, not intractable, with status epilepticus	No CC/MCC	7.613	5	755	mechanical ventilation (+2.92), icu (+1.95), n distinct rev codes (+0.94)

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

None.

Top Codes by Tier

Tier 1 (n=96 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	-1.540	2844	n distinct rev codes (-0.22), work rvu (-0.18), n j code lines (-0.16)
F22	Delusional disorders	No CC/MCC	-1.555	946	n distinct rev codes (-0.51), work rvu (+0.32), transfusion (-0.28)
H3530	Unspecified macular degeneration	No CC/MCC	-1.606	1025	n j code lines (-0.33), or (-0.24), n distinct rev codes (-0.22)
F1010	Alcohol abuse, uncomplicated	No CC/MCC	-1.625	3042	or (-0.23), n distinct rev codes (-0.22), multiple or days (-0.16)
M792	Neuralgia and neuritis, unspecified	No CC/MCC	-1.638	825	n imaging lines (-0.43), icu (-0.42), n distinct rev codes (-0.33)
G4700	Insomnia, unspecified	No CC/MCC	-1.651	14059	n distinct rev codes (-0.33), icu (-0.28), n imaging lines (-0.27)
I513	Intracardiac thrombosis, not elsewhere classified	No CC/MCC	-1.656	526	n j code lines (-0.31), or (-0.22), multiple or days (-0.16)
M25511	Pain in right shoulder	No CC/MCC	-1.762	1461	icu (-0.37), n distinct rev codes (-0.30), n imaging lines (-0.27)
G259	Extrapyramidal and movement disorder, unspecified	CC	-1.763	899	n distinct rev codes (-0.55), relative claim charge (-0.54), length of stay (+0.34)
F03918	Unspecified dementia, unspecified severity, with other behavioral disturbance	No CC/MCC	-1.771	2585	n distinct rev codes (-0.77), work rvu (+0.55), icu (-0.37)

Tier 2 (n=213 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D75839	Thrombocytosis, unspecified	No CC/MCC	0.196	1072	n distinct hcps (+0.16), multiple or days (-0.16), organ system count (+0.15)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	0.193	968	relative claim charge (-0.24), or (+0.21), icu (+0.18)
I610	Nontraumatic intracerebral hemorrhage in hemisphere, subcortical	MCC	0.181	725	n j code lines (+0.64), length of stay (-0.31), relative claim charge (+0.30)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	0.172	1897	transfusion (+0.26), n imaging lines (-0.22), work rvu (+0.15)
F319	Bipolar disorder, unspecified	No CC/MCC	0.156	3739	n imaging lines (+0.21), relative claim charge (-0.18), icu (+0.13)
N3941	Urge incontinence	No CC/MCC	0.141	704	or (+0.50), n distinct hcps (+0.43), work rvu (+0.35)
M419	Scoliosis, unspecified	No CC/MCC	0.135	540	or (+0.35), relative claim charge (-0.19), multiple or days (-0.16)
E441	Mild protein-calorie malnutrition	CC	0.132	1215	n distinct rev codes (+0.27), work rvu (-0.21), n j code lines (-0.17)
C61	Malignant neoplasm of prostate	No CC/MCC	0.121	1162	relative claim charge (-0.16), n imaging lines (+0.13), or (-0.10)
F0393	Unspecified dementia, unspecified severity, with mood disturbance	No CC/MCC	0.118	880	n imaging lines (+0.30), n distinct rev codes (+0.28), or (+0.25)

Tier 3 (n=111 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E162	Hypoglycemia, unspecified	No CC/MCC	2.390	638	icu (+0.57), n distinct rev codes (+0.51), transfusion (+0.42)
L89153	Pressure ulcer of sacral region, stage 3	MCC	2.365	720	transfusion (+0.53), relative claim charge (+0.48), n distinct rev codes (+0.40)
J189	Pneumonia, unspecified organism	MCC	2.328	4129	n distinct rev codes (+0.48), relative claim charge (+0.38), mechanical ventilation (+0.35)
G9340	Encephalopathy, unspecified	CC	2.288	7926	n imaging lines (+0.42), n j code lines (+0.41), n distinct rev codes (+0.40)
D638	Anemia in other chronic diseases classified elsewhere	No CC/MCC	2.215	2749	transfusion (+0.61), n distinct rev codes (+0.32), n j code lines (+0.21)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	2.151	1240	n distinct rev codes (+0.48), n distinct hcps (+0.46), or (+0.39)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	2.089	1446	n distinct rev codes (+0.45), icu (+0.36), transfusion (+0.27)
I161	Hypertensive emergency	CC	2.044	1937	icu (+0.73), n distinct rev codes (+0.50), n imaging lines (+0.47)
G9349	Other encephalopathy	CC	2.008	3452	n j code lines (+0.44), n distinct rev codes (+0.43), n imaging lines (+0.39)
I2489	Other forms of acute ischemic heart disease	No CC/MCC	1.970	897	icu (+0.61), n distinct rev codes (+0.58), n imaging lines (+0.57)

Tier 4 (n=36 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J690	Pneumonitis due to inhalation of food and vomit	MCC	6.426	4488	mechanical ventilation (+1.03), n distinct rev codes (+0.94), icu (+0.89)
G910	Communicating hydrocephalus	CC	6.172	875	or (+2.16), icu (+0.93), n j code lines (+0.79)
D84821	Immunodeficiency due to drugs	No CC/MCC	5.554	844	or (+0.87), transfusion (+0.86), n j code lines (+0.77)
K922	Gastrointestinal hemorrhage, unspecified	CC	5.420	588	transfusion (+2.02), multiple or days (+1.63), n j code lines (+1.17)
N170	Acute kidney failure with tubular necrosis	MCC	5.349	860	transfusion (+1.21), relative claim charge (+0.84), n distinct rev codes (+0.77)
J9811	Atelectasis	CC	4.924	2494	n distinct rev codes (+0.78), icu (+0.71), relative claim charge (+0.69)
K567	Ileus, unspecified	CC	4.919	608	multiple or days (+1.17), relative claim charge (+0.78), n distinct rev codes (+0.71)
J90	Pleural effusion, not elsewhere classified	CC	4.811	1651	n j code lines (+1.02), work rvu (+0.61), relative claim charge (+0.60)
D61818	Other pancytopenia	CC	4.518	1269	transfusion (+1.60), n distinct rev codes (+0.53), n j code lines (+0.53)
E878	Other disorders of electrolyte and fluid balance, not elsewhere classified	No CC/MCC	4.352	816	multiple or days (+1.14), n j code lines (+0.49), icu (+0.44)

Tier 5 (n=12 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	18.752	1098	mechanical ventilation (+3.73), icu (+2.53), multiple or days (+1.96)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	11.273	880	icu (+2.38), mechanical ventilation (+1.81), relative claim charge (+1.67)
E8729	Other acidosis	No CC/MCC	9.457	815	icu (+1.72), mechanical ventilation (+1.20), multiple or days (+1.11)
E873	Alkalosis	CC	8.630	781	icu (+1.32), mechanical ventilation (+1.20), n j code lines (+1.16)
J9601	Acute respiratory failure with hypoxia	MCC	8.399	6431	mechanical ventilation (+1.79), icu (+1.32), n distinct rev codes (+0.96)
D849	Immunodeficiency, unspecified	CC	8.382	632	n j code lines (+1.77), transfusion (+1.25), or (+1.07)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	8.253	694	mechanical ventilation (+2.68), icu (+1.55), relative claim charge (+1.34)
T380X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter	No CC/MCC	8.160	766	n j code lines (+1.29), transfusion (+1.25), icu (+1.15)
A419	Sepsis, unspecified organism	MCC	8.065	1930	mechanical ventilation (+1.14), n distinct rev codes (+1.07), relative claim charge (+0.99)
G7001	Myasthenia gravis with (acute) exacerbation	MCC	8.014	7585	icu (+1.63), transfusion (+1.35), or (+1.13)

Key Driver Frequency

feature	count	pct
n distinct rev codes	223	47.600
icu	189	40.400
n j code lines	167	35.700
n imaging lines	164	35.000
relative claim charge	136	29.100
or	125	26.700
transfusion	97	20.700
multiple or days	93	19.900
work rvu	71	15.200
n distinct hcps	64	13.700
organ system count	30	6.400
length of stay	21	4.500
mechanical ventilation	19	4.100
dialysis	5	1.100

PCS Codes

Data Overview

2260 total codes in komodo_rii; 60 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 44.2% of variance; PC1+PC2 together explain 57.9%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	n imaging lines	work rvu	n j code lines	organ system count	icu
1	36.000	74946.000	13.437	15.520	1.087	0.302	0.376	0.446	4.815	0.014
2	14.000	23906.000	17.290	9.819	1.297	1.424	0.883	0.758	4.841	0.346
3	5.000	6489.000	20.177	12.865	1.744	1.288	0.822	0.767	5.366	0.425
4	5.000	5292.000	22.205	13.864	2.651	1.420	1.586	1.424	5.541	0.741

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.374	-0.090
rate_icu	0.349	-0.157
avg_relative_claim_charge	0.339	-0.177
rate_or	0.323	0.013
rate_multiple_or_days	0.321	-0.073
avg_n_imaging_lines	0.288	-0.081
rate_mechanical_ventilation	0.288	-0.085
rate_transfusion	0.246	0.036
avg_n_j_code_lines	0.240	0.057
avg_organ_system_count	0.238	-0.042
avg_work_rvu	0.232	0.057
avg_n_distinct_hcps	0.046	0.019
rate_dialysis	0.020	0.010
avg_length_of_stay	-0.138	-0.029

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=36 codes)

code	Description	Score	N claims	Key drivers
F02Z3ZZ	GROOMING/PERSONAL HYGIENE ASSESSMENT	-0.845	729	organ system count (+0.41), icu (-0.24), or (-0.21)
8E0ZXY6	ISOLATION	-1.007	875	n j code lines (-0.18), multiple or days (-0.17), work rvu (-0.17)
F08Z3FZ	FEEDING/EATING TREATMENT USING ASSISTIVE, ADAPTIVE, SUPPORTIVE OR PROTECTIVE EQUIPMENT	-1.035	1451	n distinct rev codes (-0.32), icu (-0.24), n j code lines (+0.23)
F07Z4FZ	WHEELCHAIR MOBILITY TREATMENT USING ASSISTIVE, ADAPTIVE, SUPPORTIVE OR PROTECTIVE EQUIPMENT	-1.057	1189	icu (-0.24), n imaging lines (-0.21), or (-0.20)
F01ZDFZ	GAIT AND/OR BALANCE ASSESSMENT USING ASSISTIVE, ADAPTIVE, SUPPORTIVE OR PROTECTIVE EQUIPMENT	-1.158	1618	icu (-0.25), n imaging lines (-0.23), relative claim charge (-0.23)
F00ZGZZ	COMMUNICATIVE/COGNITIVE INTEGRATION SKILLS ASSESSMENT	-1.163	921	icu (-0.24), or (-0.21), n imaging lines (-0.21)
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-1.185	653	or (-0.19), multiple or days (-0.17), work rvu (-0.16)
F01ZCFZ	TRANSFER ASSESSMENT USING ASSISTIVE, ADAPTIVE, SUPPORTIVE OR PROTECTIVE EQUIPMENT	-1.188	1568	icu (-0.25), n imaging lines (-0.24), relative claim charge (-0.24)
F01ZBFZ	BED MOBILITY ASSESSMENT USING ASSISTIVE, ADAPTIVE, SUPPORTIVE OR PROTECTIVE EQUIPMENT	-1.190	1530	icu (-0.25), n imaging lines (-0.24), relative claim charge (-0.23)
F06Z6ZZ	COMMUNICATIVE/COGNITIVE INTEGRATION SKILLS TREATMENT	-1.282	5091	icu (-0.24), or (-0.20), n imaging lines (-0.20)

Tier 2 (n=14 codes)

code	Description	Score	N claims	Key drivers
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	1.970	2007	multiple or days (+0.35), n distinct rev codes (+0.32), or (+0.32)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.967	4186	or (+0.64), n imaging lines (+0.59), n distinct rev codes (+0.40)
B01B1ZZ	FLUOROSCOPY OF SPINAL CORD USING LOW OSMOLAR CONTRAST	1.738	749	or (+0.92), n imaging lines (+0.51), n distinct rev codes (+0.36)
3E03317	INTRODUCTION OF OTHER THROMBOLYTIC INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.551	857	icu (+0.88), n imaging lines (+0.75), n distinct rev codes (+0.37)
30233S1	TRANSFUSION OF NONAUTOLOGOUS GLOBULIN INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.151	1894	relative claim charge (+0.46), icu (+0.39), length of stay (+0.26)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	1.079	576	n imaging lines (+0.55), n distinct rev codes (+0.34), length of stay (+0.23)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	0.831	2762	icu (+0.26), n distinct rev codes (+0.20), relative claim charge (+0.17)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	0.804	2674	n imaging lines (+0.47), n distinct rev codes (+0.27), length of stay (+0.20)
F00ZHZZ	BEDSIDE SWALLOWING AND ORAL FUNCTION ASSESSMENT	0.663	880	work rvu (+1.15), n j code lines (+1.13), organ system count (-0.23)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	0.639	541	multiple or days (+0.23), n imaging lines (+0.20), relative claim charge (+0.12)

Tier 3 (n=5 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	4.207	2478	or (+0.79), n distinct rev codes (+0.55), multiple or days (+0.52)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.765	504	multiple or days (+1.14), n distinct rev codes (+0.61), or (+0.45)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	3.416	505	mechanical ventilation (+1.09), icu (+0.78), n distinct rev codes (+0.50)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.921	1216	transfusion (+1.51), multiple or days (+0.46), n distinct rev codes (+0.29)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	2.829	1786	or (+0.69), n distinct rev codes (+0.55), multiple or days (+0.55)

Tier 4 (n=5 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	7.159	822	relative claim charge (+1.63), mechanical ventilation (+1.09), icu (+0.89)
6A551Z3	PHERESIS OF PLASMA, MULTIPLE	5.842	1178	multiple or days (+1.04), or (+0.79), transfusion (+0.68)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	5.778	1750	mechanical ventilation (+0.95), relative claim charge (+0.92), icu (+0.89)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	5.671	1027	mechanical ventilation (+1.09), icu (+0.94), n distinct rev codes (+0.82)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	5.225	515	multiple or days (+1.06), work rvu (+0.74), n j code lines (+0.72)

Key Driver Frequency

feature	count	pct
icu	36	60.000
or	26	43.300
n distinct rev codes	26	43.300
n imaging lines	25	41.700
work rvu	12	20.000
relative claim charge	12	20.000
n j code lines	11	18.300
multiple or days	10	16.700
organ system count	10	16.700
length of stay	5	8.300
mechanical ventilation	4	6.700
transfusion	2	3.300
dialysis	1	1.700