IP - NU.1.stroke

CM Codes

Data Overview

13822 total codes in komodo_rii; 489 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	294
CC	106
MCC	89

PCA Analysis

PC1 explains 42.2% of variance; PC1+PC2 together explain 55.8%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	organ system count	work rvu	n j code lines	icu	mechanical ventilation
1	309.000	2807925.000	6.369	18.767	0.982	5.208	0.559	0.327	0.443	0.031
2	135.000	930330.000	8.316	20.130	1.268	5.456	0.682	0.451	0.548	0.078
3	45.000	221500.000	10.421	21.564	1.766	5.614	0.904	0.664	0.685	0.249

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	49	39	18	106
MCC	35	35	19	89
No CC/MCC	225	61	8	294
All	309	135	45	489

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.388	-0.063	0.426
rate_or	0.373	-0.086	0.440
avg_n_distinct_rev_codes	0.323	-0.133	0.220
avg_n_j_code_lines	0.322	0.015	0.424
rate_icu	0.320	0.022	0.362
avg_length_of_stay	0.311	-0.098	0.265
rate_transfusion	0.284	-0.028	0.408
rate_mechanical_ventilation	0.283	0.034	0.488
rate_multiple_or_days	0.242	0.069	0.153
avg_work_rvu	0.217	-0.034	0.234
avg_n_distinct_hcps	0.118	-0.115	-0.291
avg_organ_system_count	0.110	-0.238	-0.414
rate_dialysis	0.094	0.015	0.374
avg_n_imaging_lines	0.041	-0.251	0.073

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
G40901	Epilepsy, unspecified, not intractable, with status epilepticus	No CC/MCC	7.660	3	1283	mechanical ventilation (+1.42), relative claim charge (+1.07), or (+1.07)
E8770	Fluid overload, unspecified	No CC/MCC	7.341	3	1082	relative claim charge (+1.13), or (+0.97), n j code lines (+0.95)
E8339	Other disorders of phosphorus metabolism	No CC/MCC	5.709	3	6589	multiple or days (+0.78), relative claim charge (+0.73), or (+0.73)
J1282	Pneumonia due to coronavirus disease 2019	No CC/MCC	5.192	3	889	n j code lines (+1.59), relative claim charge (+1.11), length of stay (+0.73)
B952	Enterococcus as the cause of diseases classified elsewhere	No CC/MCC	4.851	3	1419	n j code lines (+1.30), length of stay (+0.66), multiple or days (+0.62)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I6381	Other cerebral infarction due to occlusion or stenosis of small artery	MCC	-3.335	1	53298	or (-0.48), relative claim charge (-0.44), icu (-0.42)
I6389	Other cerebral infarction	MCC	-2.697	1	53032	or (-0.41), relative claim charge (-0.36), length of stay (-0.31)
I6329	Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries	MCC	-2.692	1	9453	icu (-0.49), or (-0.43), relative claim charge (-0.33)
I639	Cerebral infarction, unspecified	MCC	-2.675	1	164773	or (-0.38), relative claim charge (-0.37), icu (-0.33)
I63549	Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery	MCC	-2.459	1	1601	relative claim charge (-0.35), or (-0.31), length of stay (-0.31)

Top Codes by Tier

Tier 1 (n=309 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I69392	Facial weakness following cerebral infarction	No CC/MCC	-0.027	3727	length of stay (+0.81), n distinct rev codes (+0.39), or (-0.29)
C3490	Malignant neoplasm of unspecified part of unspecified bronchus or lung	CC	-0.029	2020	work rvu (+0.52), transfusion (+0.21), relative claim charge (-0.21)
F1120	Opioid dependence, uncomplicated	CC	-0.078	2001	multiple or days (+0.24), n distinct hcps (-0.16), n j code lines (+0.16)
I69320	Aphasia following cerebral infarction	No CC/MCC	-0.121	6964	length of stay (+0.55), n distinct rev codes (+0.25), n j code lines (-0.23)
K3184	Gastroparesis	No CC/MCC	-0.125	1016	work rvu (-0.20), icu (-0.19), organ system count (+0.18)
I77810	Thoracic aortic ectasia	No CC/MCC	-0.132	1446	multiple or days (+0.62), transfusion (-0.20), or (-0.19)
C259	Malignant neoplasm of pancreas, unspecified	CC	-0.137	1147	multiple or days (+0.44), transfusion (+0.35), icu (-0.23)
L03116	Cellulitis of left lower limb	CC	-0.138	987	work rvu (-0.33), n distinct rev codes (+0.32), multiple or days (-0.25)
I2489	Other forms of acute ischemic heart disease	No CC/MCC	-0.164	5695	n j code lines (+0.15), n distinct rev codes (+0.14), or (-0.11)
E8352	Hypercalcemia	No CC/MCC	-0.179	2270	n j code lines (-0.25), n distinct rev codes (+0.17), icu (-0.12)

Tier 2 (n=135 codes)

code	Description	CMS severity	Score	N claims	Key drivers
Q282	Arteriovenous malformation of cerebral vessels	MCC	3.562	1031	or (+1.77), multiple or days (+0.63), icu (+0.61)
S065XAA	Traumatic subdural hemorrhage with loss of consciousness status unknown, initial encounter	No CC/MCC	3.529	1189	work rvu (+1.14), multiple or days (+0.66), n j code lines (+0.64)
J189	Pneumonia, unspecified organism	MCC	3.482	11634	relative claim charge (+0.65), n distinct rev codes (+0.56), or (+0.42)
K766	Portal hypertension	CC	3.444	993	transfusion (+1.32), or (+0.66), n distinct rev codes (+0.42)
D6959	Other secondary thrombocytopenia	No CC/MCC	3.299	1532	transfusion (+1.40), relative claim charge (+0.36), or (+0.31)
G936	Cerebral edema	MCC	3.292	50030	icu (+0.90), n j code lines (+0.55), or (+0.53)
G928	Other toxic encephalopathy	No CC/MCC	3.287	11068	relative claim charge (+0.72), n distinct rev codes (+0.61), length of stay (+0.53)
J811	Chronic pulmonary edema	CC	3.213	1483	relative claim charge (+0.68), or (+0.67), n distinct rev codes (+0.47)
D849	Immunodeficiency, unspecified	CC	3.168	1307	n j code lines (+0.95), transfusion (+0.49), multiple or days (+0.47)
D693	Immune thrombocytopenic purpura	CC	3.147	881	transfusion (+1.34), n j code lines (+0.60), relative claim charge (+0.47)

Tier 3 (n=45 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K567	Ileus, unspecified	CC	10.168	979	relative claim charge (+2.11), length of stay (+1.55), or (+1.29)
D62	Acute posthemorrhagic anemia	CC	9.131	4948	transfusion (+2.43), relative claim charge (+1.16), or (+1.06)
E874	Mixed disorder of acid-base balance	CC	7.934	1069	relative claim charge (+1.36), or (+1.16), n distinct rev codes (+0.98)
N170	Acute kidney failure with tubular necrosis	MCC	7.691	4245	relative claim charge (+1.45), n distinct rev codes (+1.06), or (+0.99)
G40901	Epilepsy, unspecified, not intractable, with status epilepticus	No CC/MCC	7.660	1283	mechanical ventilation (+1.42), relative claim charge (+1.07), or (+1.07)
E873	Alkalosis	CC	7.542	2110	n j code lines (+1.39), relative claim charge (+1.17), or (+0.93)
E8770	Fluid overload, unspecified	No CC/MCC	7.341	1082	relative claim charge (+1.13), or (+0.97), n j code lines (+0.95)
A419	Sepsis, unspecified organism	MCC	7.311	9790	relative claim charge (+1.25), or (+0.95), n distinct rev codes (+0.89)
A0472	Enterocolitis due to Clostridium difficile, not specified as recurrent	CC	7.232	1083	relative claim charge (+1.53), length of stay (+1.29), n j code lines (+1.04)
J690	Pneumonitis due to inhalation of food and vomit	MCC	7.209	17412	relative claim charge (+1.36), or (+1.05), n distinct rev codes (+0.85)

Key Driver Frequency

feature	count	pct
relative claim charge	254	51.900
or	239	48.900
n j code lines	183	37.400
n distinct rev codes	173	35.400
icu	155	31.700
length of stay	134	27.400
multiple or days	109	22.300
work rvu	87	17.800
transfusion	58	11.900
organ system count	29	5.900
mechanical ventilation	20	4.100
n distinct hcps	19	3.900
dialysis	7	1.400

PCS Codes

Data Overview

2924 total codes in komodo_rii; 67 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 38.7% of variance; PC1+PC2 together explain 55.8%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	or	icu	work rvu	n j code lines
1	17.000	86631.000	18.277	6.204	1.037	4.423	0.086	0.424	0.395	0.438
2	15.000	48201.000	20.680	8.064	1.545	4.833	0.235	0.588	0.565	0.575
3	35.000	126241.000	23.171	10.236	2.125	4.983	0.567	0.776	0.746	0.746

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.405	0.049
avg_n_distinct_rev_codes	0.373	-0.010
rate_icu	0.345	0.026
rate_or	0.335	-0.068
avg_length_of_stay	0.307	-0.004
avg_n_j_code_lines	0.278	0.132
avg_organ_system_count	0.254	0.060
rate_multiple_or_days	0.248	-0.075
avg_work_rvu	0.247	0.218
avg_n_distinct_hcps	0.210	-0.096
rate_mechanical_ventilation	0.175	0.124
rate_transfusion	0.159	0.122
avg_n_imaging_lines	0.072	-0.044
rate_dialysis	0.035	0.224

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=17 codes)

code	Description	Score	N claims	Key drivers
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	-2.314	10129	icu (-0.38), relative claim charge (-0.38), or (-0.30)
8E0ZXY6	ISOLATION	-2.510	1868	n distinct rev codes (-0.48), n j code lines (-0.41), icu (-0.41)
B246ZZ4	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART, TRANSESOPHAGEAL	-2.535	3632	relative claim charge (-0.37), icu (-0.36), or (-0.30)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-2.653	1062	relative claim charge (-0.63), n distinct rev codes (-0.46), or (-0.39)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-2.670	7541	relative claim charge (-0.54), icu (-0.38), n distinct rev codes (-0.35)
B030ZZZ	MAGNETIC RESONANCE IMAGING (MRI) OF BRAIN	-2.942	2932	icu (-0.79), relative claim charge (-0.57), n distinct rev codes (-0.45)
BW191ZZ	FLUOROSCOPY OF HEAD AND NECK USING LOW OSMOLAR CONTRAST	-3.001	1603	n distinct hcps (+0.61), n distinct rev codes (-0.59), relative claim charge (-0.57)
F07Z9ZZ	GAIT TRAINING/FUNCTIONAL AMBULATION TREATMENT	-3.034	938	icu (-0.59), relative claim charge (-0.51), n distinct hcps (-0.48)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-3.286	2624	n distinct rev codes (-0.63), relative claim charge (-0.58), icu (-0.44)
B32R1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF INTRACRANIAL ARTERIES USING LOW OSMOLAR CONTRAST	-3.315	4776	relative claim charge (-0.50), n distinct rev codes (-0.47), n j code lines (-0.40)

Tier 2 (n=15 codes)

code	Description	Score	N claims	Key drivers
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	0.397	1817	n distinct hcps (-0.35), n j code lines (+0.25), or (+0.16)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	-0.068	8762	or (-0.22), work rvu (+0.16), n j code lines (+0.15)
B31Q1ZZ	FLUOROSCOPY OF CERVICO-CEREBRAL ARCH USING LOW OSMOLAR CONTRAST	-0.071	921	or (+0.50), n j code lines (-0.32), work rvu (-0.32)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.466	6878	organ system count (+0.33), dialysis (+0.27), icu (-0.23)
4A00X4Z	MEASUREMENT OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	-0.635	3871	work rvu (+0.44), n j code lines (+0.34), or (-0.27)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.741	5153	or (-0.23), n j code lines (-0.19), organ system count (+0.15)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	-0.895	3414	n j code lines (+0.69), work rvu (+0.68), relative claim charge (-0.54)
HZ2ZZZZ	DETOXIFICATION SERVICES FOR SUBSTANCE ABUSE TREATMENT	-0.966	924	or (-0.32), relative claim charge (-0.22), n distinct rev codes (-0.15)
30283B1	TRANSFUSION OF NONAUTOLOGOUS 4-FACTOR PROTHROMBIN COMPLEX CONCENTRATE INTO VEIN, PERCUTANEOUS APPROACH	-1.029	1548	icu (+0.36), n distinct rev codes (-0.34), n j code lines (-0.30)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-1.077	2171	n distinct rev codes (-0.56), icu (-0.26), n distinct hcps (+0.22)

Tier 3 (n=35 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	4.123	5651	relative claim charge (+1.22), length of stay (+0.70), icu (+0.54)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	3.255	8535	length of stay (+1.05), n distinct rev codes (+0.72), relative claim charge (+0.71)
06H03DZ	INSERTION OF INTRALUMINAL DEVICE INTO INFERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.253	1185	relative claim charge (+0.64), n distinct rev codes (+0.62), or (+0.49)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	3.113	6672	length of stay (+0.81), relative claim charge (+0.50), n distinct rev codes (+0.46)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.016	2037	n distinct rev codes (+0.75), length of stay (+0.71), relative claim charge (+0.47)
B31D1ZZ	FLUOROSCOPY OF RIGHT VERTEBRAL ARTERY USING LOW OSMOLAR CONTRAST	2.842	1272	multiple or days (+0.92), or (+0.56), work rvu (+0.49)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	2.773	9485	relative claim charge (+0.53), length of stay (+0.36), n distinct rev codes (+0.36)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	2.736	1223	icu (+0.53), organ system count (+0.46), relative claim charge (+0.42)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	2.585	2940	n j code lines (+0.73), length of stay (+0.54), work rvu (+0.49)
B31C1ZZ	FLUOROSCOPY OF BILATERAL EXTERNAL CAROTID ARTERIES USING LOW OSMOLAR CONTRAST	2.480	2605	multiple or days (+0.64), or (+0.54), n j code lines (+0.46)

Key Driver Frequency

feature	count	pct
icu	33	49.300
relative claim charge	32	47.800
n distinct rev codes	32	47.800
or	28	41.800
organ system count	16	23.900
n j code lines	16	23.900
length of stay	12	17.900
work rvu	9	13.400
n distinct hcps	9	13.400
mechanical ventilation	6	9.000
multiple or days	5	7.500
transfusion	2	3.000
dialysis	1	1.500