IP - OB.1.C_section

CM Codes

Data Overview

8637 total codes in komodo_rii; 243 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	190
CC	36
MCC	17

PCA Analysis

PC1 explains 48.2% of variance; PC1+PC2 together explain 61.2%.

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	n j code lines	transfusion	icu
1	179.000	2268089.000	12.613	3.106	1.592	1.061	0.034	0.683	0.083	0.038
2	49.000	235851.000	13.654	4.048	2.023	1.285	0.095	0.758	0.149	0.074
3	14.000	24126.000	15.823	5.738	2.472	1.852	0.254	0.898	0.273	0.174
4	1.000	1474.000	17.927	5.534	3.236	2.213	0.462	1.024	0.426	0.350

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	15	16	5	0	36
MCC	8	8	1	0	17
No CC/MCC	156	25	8	1	190
All	179	49	14	1	243

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
rate_icu	0.365	-0.241	0.396
avg_n_distinct_rev_codes	0.363	-0.357	0.415
avg_relative_claim_charge	0.354	-0.328	0.439
avg_n_imaging_lines	0.349	-0.242	0.359
rate_mechanical_ventilation	0.341	-0.205	0.353
rate_dialysis	0.318	0.082	0.280
rate_transfusion	0.289	-0.277	0.389
avg_length_of_stay	0.271	-0.386	0.244
avg_n_j_code_lines	0.212	-0.150	0.215
avg_organ_system_count	0.179	-0.186	0.045
rate_multiple_or_days	0.151	-0.135	0.002
avg_n_distinct_hcps	0.104	-0.319	-0.049
avg_work_rvu	0.000	-0.271	-0.063
rate_or	-0.054	-0.185	-0.031

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (1 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E8720	Acidosis, unspecified	No CC/MCC	18.048	4	1474	mechanical ventilation (+3.37), dialysis (+3.32), icu (+2.55)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K831	Obstruction of bile duct	MCC	-0.722	1	2637	icu (-0.19), dialysis (+0.19), relative claim charge (-0.15)
O3433	Maternal care for cervical incompetence, third trimester	MCC	-0.464	1	2700	n j code lines (+0.19), organ system count (-0.15), n imaging lines (-0.14)
O6014X2	Preterm labor third trimester with preterm delivery third trimester, fetus 2	MCC	-0.430	1	1871	n distinct rev codes (+0.24), n imaging lines (-0.18), organ system count (-0.18)
O6014X1	Preterm labor third trimester with preterm delivery third trimester, fetus 1	MCC	-0.320	1	1885	n distinct rev codes (+0.28), multiple or days (-0.22), organ system count (-0.18)
O411230	Chorioamnionitis, third trimester, not applicable or unspecified	MCC	-0.262	1	15897	organ system count (-0.20), n j code lines (+0.18), n distinct rev codes (+0.14)

Top Codes by Tier

Tier 1 (n=179 codes)

code	Description	CMS severity	Score	N claims	Key drivers
O6014X0	Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified	MCC	0.120	17061	n distinct rev codes (+0.31), organ system count (-0.13), relative claim charge (+0.09)
E785	Hyperlipidemia, unspecified	No CC/MCC	0.085	1815	dialysis (+0.33), organ system count (+0.25), multiple or days (-0.17)
O09513	Supervision of elderly primigravida, third trimester	No CC/MCC	0.045	1301	n j code lines (+0.43), n distinct hcps (+0.33), transfusion (-0.24)
O322XX2	Maternal care for transverse and oblique lie, fetus 2	No CC/MCC	0.022	1479	length of stay (+0.19), organ system count (-0.16), relative claim charge (+0.13)
D500	Iron deficiency anemia secondary to blood loss (chronic)	No CC/MCC	-0.084	2182	transfusion (+0.26), mechanical ventilation (-0.16), length of stay (-0.13)
U071	COVID-19	MCC	-0.101	2029	organ system count (-0.13), multiple or days (-0.13), n distinct hcps (+0.09)
O99892	Other specified diseases and conditions complicating childbirth	No CC/MCC	-0.104	26329	relative claim charge (-0.12), organ system count (+0.10), n distinct hcps (+0.09)
J4540	Moderate persistent asthma, uncomplicated	No CC/MCC	-0.155	1102	n j code lines (-0.36), organ system count (+0.34), dialysis (-0.12)
O99324	Drug use complicating childbirth	CC	-0.182	12359	n j code lines (-0.35), mechanical ventilation (+0.17), organ system count (+0.15)
F1120	Opioid dependence, uncomplicated	CC	-0.191	1543	n j code lines (-0.35), organ system count (+0.21), mechanical ventilation (+0.11)

Tier 2 (n=49 codes)

code	Description	CMS severity	Score	N claims	Key drivers
O9913	Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating the puerperium	CC	3.542	1241	icu (+0.68), n imaging lines (+0.57), n distinct rev codes (+0.43)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	3.511	2249	icu (+0.66), mechanical ventilation (+0.53), n imaging lines (+0.48)
N390	Urinary tract infection, site not specified	CC	3.265	1674	n distinct rev codes (+0.61), multiple or days (+0.51), relative claim charge (+0.41)
O42113	Preterm premature rupture of membranes, onset of labor more than 24 hours following rupture, third trimester	No CC/MCC	3.065	1503	length of stay (+1.16), relative claim charge (+1.11), n distinct rev codes (+0.61)
O8612	Endometritis following delivery	CC	3.064	1981	n imaging lines (+0.84), n distinct rev codes (+0.62), relative claim charge (+0.47)
I959	Hypotension, unspecified	No CC/MCC	2.996	2403	transfusion (+0.60), n imaging lines (+0.42), icu (+0.41)
O9963	Diseases of the digestive system complicating the puerperium	No CC/MCC	2.991	2176	n imaging lines (+0.87), transfusion (+0.36), relative claim charge (+0.29)
O720	Third-stage hemorrhage	CC	2.933	1185	transfusion (+1.35), relative claim charge (+0.76), icu (+0.44)
O9942	Diseases of the circulatory system complicating childbirth	MCC	2.875	7148	icu (+0.58), n imaging lines (+0.51), mechanical ventilation (+0.41)
O4413	Complete placenta previa with hemorrhage, third trimester	MCC	2.575	2080	transfusion (+0.72), relative claim charge (+0.66), length of stay (+0.57)

Tier 3 (n=14 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N179	Acute kidney failure, unspecified	CC	10.709	2386	dialysis (+1.60), icu (+1.44), mechanical ventilation (+1.41)
E8351	Hypocalcemia	No CC/MCC	10.392	1065	mechanical ventilation (+1.67), icu (+1.59), n distinct rev codes (+1.27)
K567	Ileus, unspecified	CC	10.347	1465	n imaging lines (+2.24), n distinct rev codes (+1.28), relative claim charge (+1.28)
O99285	Endocrine, nutritional and metabolic diseases complicating the puerperium	No CC/MCC	9.278	1228	n imaging lines (+1.38), mechanical ventilation (+1.35), icu (+1.34)
E871	Hypo-osmolality and hyponatremia	CC	8.929	2452	icu (+1.40), n imaging lines (+1.34), dialysis (+1.28)
O42912	Preterm premature rupture of membranes, unspecified as to length of time between rupture and onset of labor, second trimester	No CC/MCC	7.266	1173	length of stay (+2.10), relative claim charge (+1.63), n distinct rev codes (+1.10)
O9A22	Injury, poisoning and certain other consequences of external causes complicating childbirth	No CC/MCC	7.234	1349	n imaging lines (+1.42), mechanical ventilation (+1.16), relative claim charge (+0.99)
O365920	Maternal care for other known or suspected poor fetal growth, second trimester, not applicable or unspecified	No CC/MCC	7.109	1250	length of stay (+1.90), relative claim charge (+1.62), icu (+0.99)
E876	Hypokalemia	No CC/MCC	6.861	2168	mechanical ventilation (+1.17), n distinct rev codes (+1.08), n imaging lines (+1.05)
O9943	Diseases of the circulatory system complicating the puerperium	CC	6.288	1364	n imaging lines (+1.38), icu (+0.98), n distinct rev codes (+0.82)

Tier 4 (n=1 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E8720	Acidosis, unspecified	No CC/MCC	18.048	1474	mechanical ventilation (+3.37), dialysis (+3.32), icu (+2.55)

Key Driver Frequency

feature	count	pct
n distinct rev codes	126	51.900
relative claim charge	104	42.800
icu	94	38.700
organ system count	88	36.200
n j code lines	60	24.700
n imaging lines	55	22.600
transfusion	51	21.000
length of stay	46	18.900
multiple or days	36	14.800
mechanical ventilation	36	14.800
dialysis	16	6.600
n distinct hcps	16	6.600
or	1	0.400

PCS Codes

Data Overview

2195 total codes in komodo_rii; 46 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 51.0% of variance; PC1+PC2 together explain 66.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	transfusion	n j code lines	icu	n imaging lines
1	41.000	918102.000	12.725	3.118	1.072	1.368	0.083	0.702	0.037	0.034
2	4.000	22956.000	14.552	4.186	1.556	1.758	0.523	0.725	0.111	0.118
3	1.000	1117.000	17.876	5.134	2.369	2.401	0.972	1.019	0.332	0.324

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_imaging_lines	0.366	0.072
rate_icu	0.359	0.183
avg_relative_claim_charge	0.356	0.165
rate_mechanical_ventilation	0.353	-0.110
rate_dialysis	0.339	0.106
rate_transfusion	0.334	-0.177
avg_n_distinct_rev_codes	0.310	-0.090
avg_length_of_stay	0.241	0.046
avg_organ_system_count	0.241	-0.187
avg_n_j_code_lines	0.141	-0.007
avg_work_rvu	0.118	-0.014
rate_multiple_or_days	0.098	0.267
avg_n_distinct_hcps	0.055	-0.170
rate_or	0.026	-0.067

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=41 codes)

code	Description	Score	N claims	Key drivers
0JHF3HZ	INSERTION OF CONTRACEPTIVE DEVICE INTO LEFT UPPER ARM SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	0.958	3710	work rvu (+0.25), multiple or days (+0.21), organ system count (+0.21)
0UQ90ZZ	REPAIR UTERUS, OPEN APPROACH	0.805	4027	n imaging lines (+0.24), multiple or days (+0.13), mechanical ventilation (+0.13)
0UCC7ZZ	EXTIRPATION OF MATTER FROM CERVIX, VIA NATURAL OR ARTIFICIAL OPENING	0.665	1927	length of stay (+0.53), relative claim charge (+0.23), work rvu (-0.12)
0UB90ZZ	EXCISION OF UTERUS, OPEN APPROACH	0.474	1276	work rvu (+0.27), organ system count (+0.21), dialysis (-0.19)
0UH90HZ	INSERTION OF CONTRACEPTIVE DEVICE INTO UTERUS, OPEN APPROACH	0.442	4824	n distinct rev codes (-0.27), multiple or days (+0.26), organ system count (+0.22)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.203	3601	dialysis (+0.58), organ system count (+0.33), n j code lines (-0.31)
3E0P7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO FEMALE REPRODUCTIVE, VIA NATURAL OR ARTIFICIAL OPENING	-0.049	1853	organ system count (-0.20), dialysis (-0.19), n distinct rev codes (+0.18)
4A0HXCZ	MEASUREMENT OF PRODUCTS OF CONCEPTION, CARDIAC RATE, EXTERNAL APPROACH	-0.173	2249	length of stay (+0.23), dialysis (-0.19), n j code lines (-0.12)
0U7C7ZZ	DILATION OF CERVIX, VIA NATURAL OR ARTIFICIAL OPENING	-0.309	30535	length of stay (+0.19), mechanical ventilation (-0.11), n imaging lines (-0.10)
4A1H74Z	MONITORING OF PRODUCTS OF CONCEPTION, CARDIAC ELECTRICAL ACTIVITY, VIA NATURAL OR ARTIFICIAL OPENING	-0.364	2090	n j code lines (+0.37), dialysis (-0.19), icu (-0.17)

Tier 2 (n=4 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	5.379	11798	transfusion (+1.36), n imaging lines (+0.83), n distinct rev codes (+0.66)
0W3R7ZZ	CONTROL BLEEDING IN GENITOURINARY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	4.096	2988	relative claim charge (+0.78), transfusion (+0.78), icu (+0.54)
10D00Z0	EXTRACTION OF PRODUCTS OF CONCEPTION, HIGH, OPEN APPROACH	4.047	6706	relative claim charge (+0.74), length of stay (+0.70), icu (+0.59)
0W3R0ZZ	CONTROL BLEEDING IN GENITOURINARY TRACT, OPEN APPROACH	2.295	1464	relative claim charge (+0.41), transfusion (+0.37), n imaging lines (+0.32)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
30233K1	TRANSFUSION OF NONAUTOLOGOUS FROZEN PLASMA INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	14.702	1117	mechanical ventilation (+2.20), icu (+2.04), n imaging lines (+2.02)

Key Driver Frequency

feature	count	pct
organ system count	22	47.800
relative claim charge	16	34.800
n imaging lines	16	34.800
dialysis	16	34.800
n distinct rev codes	15	32.600
length of stay	13	28.300
icu	13	28.300
n j code lines	9	19.600
work rvu	6	13.000
mechanical ventilation	5	10.900
transfusion	4	8.700
multiple or days	3	6.500