IP - OB.1.antepartum

CM Codes

Data Overview

10438 total codes in komodo_rii; 344 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	245
CC	77
MCC	22

PCA Analysis

PC1 explains 33.7% of variance; PC1+PC2 together explain 59.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	organ system count	length of stay	relative claim charge	n imaging lines	or	icu	work rvu
1	217.000	2087643.000	10.460	1.249	3.044	1.071	0.033	0.349	0.022	0.393
2	106.000	359245.000	10.462	2.324	3.770	1.119	0.172	0.133	0.086	0.245
3	21.000	51506.000	12.410	3.115	4.112	1.503	0.375	0.113	0.241	0.247

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	34	35	8	77
MCC	12	5	5	22
No CC/MCC	171	66	8	245
All	217	106	21	344

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
rate_icu	0.419	-0.263	0.312
avg_n_imaging_lines	0.402	-0.256	0.246
avg_organ_system_count	0.369	-0.213	0.139
rate_mechanical_ventilation	0.344	-0.051	0.153
rate_dialysis	0.313	-0.112	0.274
avg_length_of_stay	0.231	-0.284	0.209
avg_relative_claim_charge	0.228	-0.168	0.119
avg_n_distinct_rev_codes	0.170	-0.059	0.078
rate_transfusion	0.152	-0.143	0.163
rate_multiple_or_days	-0.030	0.217	-0.039
avg_n_j_code_lines	-0.088	-0.008	-0.041
avg_work_rvu	-0.152	0.014	-0.129
rate_or	-0.238	0.108	-0.260
avg_n_distinct_hcps	-0.254	0.159	-0.231

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
E8720	Acidosis, unspecified	No CC/MCC	8.833	3	2662	dialysis (+2.01), icu (+1.61), mechanical ventilation (+1.39)
O99351	Diseases of the nervous system complicating pregnancy, first trimester	No CC/MCC	7.488	3	1767	n imaging lines (+2.07), mechanical ventilation (+1.88), icu (+1.06)
O9A212	Injury, poisoning and certain other consequences of external causes complicating pregnancy, second trimester	No CC/MCC	5.644	3	1264	n imaging lines (+1.87), mechanical ventilation (+1.04), icu (+0.78)
O99511	Diseases of the respiratory system complicating pregnancy, first trimester	No CC/MCC	5.029	3	2688	mechanical ventilation (+0.98), icu (+0.92), n imaging lines (+0.72)
O99352	Diseases of the nervous system complicating pregnancy, second trimester	No CC/MCC	4.949	3	3528	n imaging lines (+1.80), icu (+0.75), organ system count (+0.66)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
O411230	Chorioamnionitis, third trimester, not applicable or unspecified	MCC	-1.114	1	15805	organ system count (-0.44), relative claim charge (+0.28), n imaging lines (-0.25)
O6003	Preterm labor without delivery, third trimester	MCC	-1.099	1	16827	relative claim charge (-0.48), organ system count (-0.33), or (+0.32)
O2412	Pre-existing type 2 diabetes mellitus, in childbirth	MCC	-1.009	1	3049	or (-0.43), n distinct hcps (-0.38), relative claim charge (+0.32)
K831	Obstruction of bile duct	MCC	-0.874	1	1991	icu (-0.23), n imaging lines (-0.21), work rvu (-0.15)
O6014X0	Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified	MCC	-0.766	1	7562	organ system count (-0.37), n distinct hcps (-0.29), n distinct rev codes (+0.26)

Top Codes by Tier

Tier 1 (n=217 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D509	Iron deficiency anemia, unspecified	No CC/MCC	0.063	19857	organ system count (+0.21), transfusion (+0.15), dialysis (-0.11)
O114	Pre-existing hypertension with pre-eclampsia, complicating childbirth	No CC/MCC	0.012	1432	relative claim charge (+0.50), n distinct rev codes (+0.42), or (-0.40)
O210	Mild hyperemesis gravidarum	No CC/MCC	0.004	5990	or (+0.25), n distinct hcps (+0.25), relative claim charge (-0.17)
O1415	Severe pre-eclampsia, complicating the puerperium	No CC/MCC	-0.003	1089	relative claim charge (+0.38), length of stay (+0.32), n distinct rev codes (+0.30)
F1290	Cannabis use, unspecified, uncomplicated	No CC/MCC	-0.055	6528	organ system count (+0.21), length of stay (-0.13), relative claim charge (-0.12)
O4412	Complete placenta previa with hemorrhage, second trimester	MCC	-0.109	1221	organ system count (-0.33), n distinct hcps (+0.30), n distinct rev codes (-0.29)
O23593	Infection of other part of genital tract in pregnancy, third trimester	CC	-0.122	2835	or (+0.15), work rvu (+0.12), icu (-0.11)
O99810	Abnormal glucose complicating pregnancy	No CC/MCC	-0.134	1032	relative claim charge (-0.19), icu (+0.18), or (+0.17)
O1413	Severe pre-eclampsia, third trimester	MCC	-0.140	2581	n distinct hcps (+0.33), organ system count (-0.25), or (+0.20)
O2343	Unspecified infection of urinary tract in pregnancy, third trimester	CC	-0.147	4887	dialysis (-0.14), or (+0.12), work rvu (+0.11)

Tier 2 (n=106 codes)

code	Description	CMS severity	Score	N claims	Key drivers
O99012	Anemia complicating pregnancy, second trimester	No CC/MCC	3.625	8645	n imaging lines (+0.51), icu (+0.46), organ system count (+0.45)
O26612	Liver and biliary tract disorders in pregnancy, second trimester	CC	3.621	1181	n imaging lines (+1.12), dialysis (+0.51), organ system count (+0.44)
O98512	Other viral diseases complicating pregnancy, second trimester	CC	3.336	1379	n imaging lines (+0.60), icu (+0.58), dialysis (+0.42)
O99282	Endocrine, nutritional and metabolic diseases complicating pregnancy, second trimester	No CC/MCC	3.319	8448	icu (+0.66), n imaging lines (+0.58), organ system count (+0.55)
E876	Hypokalemia	No CC/MCC	3.169	8845	icu (+0.70), organ system count (+0.61), n imaging lines (+0.58)
O99281	Endocrine, nutritional and metabolic diseases complicating pregnancy, first trimester	No CC/MCC	3.124	6113	icu (+0.68), n imaging lines (+0.52), organ system count (+0.47)
O24012	Pre-existing type 1 diabetes mellitus, in pregnancy, second trimester	CC	2.899	1369	icu (+1.27), dialysis (+0.52), organ system count (+0.36)
O99211	Obesity complicating pregnancy, first trimester	No CC/MCC	2.808	2013	n imaging lines (+0.68), icu (+0.60), organ system count (+0.45)
O99331	Smoking (tobacco) complicating pregnancy, first trimester	No CC/MCC	2.586	1898	icu (+0.55), organ system count (+0.48), n imaging lines (+0.40)
O26891	Other specified pregnancy related conditions, first trimester	No CC/MCC	2.578	1680	n imaging lines (+0.84), icu (+0.57), organ system count (+0.32)

Tier 3 (n=21 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9601	Acute respiratory failure with hypoxia	MCC	15.120	1796	mechanical ventilation (+4.97), icu (+3.13), n imaging lines (+1.65)
E8720	Acidosis, unspecified	No CC/MCC	8.833	2662	dialysis (+2.01), icu (+1.61), mechanical ventilation (+1.39)
O99351	Diseases of the nervous system complicating pregnancy, first trimester	No CC/MCC	7.488	1767	n imaging lines (+2.07), mechanical ventilation (+1.88), icu (+1.06)
N179	Acute kidney failure, unspecified	CC	7.113	1943	dialysis (+2.24), icu (+1.29), organ system count (+0.77)
J189	Pneumonia, unspecified organism	MCC	6.706	1532	n imaging lines (+1.51), icu (+1.24), mechanical ventilation (+0.70)
O99111	Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester	CC	6.341	1548	dialysis (+1.47), icu (+1.05), n imaging lines (+0.90)
O26832	Pregnancy related renal disease, second trimester	CC	5.850	1762	dialysis (+3.15), n imaging lines (+0.75), organ system count (+0.52)
O9A212	Injury, poisoning and certain other consequences of external causes complicating pregnancy, second trimester	No CC/MCC	5.644	1264	n imaging lines (+1.87), mechanical ventilation (+1.04), icu (+0.78)
O99412	Diseases of the circulatory system complicating pregnancy, second trimester	CC	5.590	2052	icu (+1.38), n imaging lines (+1.08), organ system count (+0.67)
A419	Sepsis, unspecified organism	MCC	5.504	3230	icu (+1.42), n imaging lines (+0.99), organ system count (+0.74)

Key Driver Frequency

feature	count	pct
organ system count	224	65.100
n imaging lines	173	50.300
icu	160	46.500
n distinct hcps	122	35.500
or	116	33.700
relative claim charge	65	18.900
length of stay	58	16.900
dialysis	33	9.600
n distinct rev codes	28	8.100
work rvu	23	6.700
mechanical ventilation	13	3.800
transfusion	9	2.600
n j code lines	7	2.000
multiple or days	1	0.300

PCS Codes

Data Overview

1546 total codes in komodo_rii; 40 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 54.2% of variance; PC1+PC2 together explain 72.1%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	relative claim charge	n j code lines	n imaging lines	or	icu
1	33.000	487550.000	2.811	10.650	0.779	1.034	0.533	0.016	0.344	0.009
2	6.000	14162.000	3.380	11.966	1.267	1.335	0.818	0.066	0.613	0.029
3	1.000	1165.000	8.150	15.623	2.971	2.976	1.011	0.423	0.689	0.303

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.356	-0.215
avg_length_of_stay	0.345	-0.179
rate_icu	0.344	-0.209
avg_n_imaging_lines	0.342	-0.393
rate_dialysis	0.342	-0.068
rate_mechanical_ventilation	0.333	-0.055
avg_organ_system_count	0.326	-0.429
avg_n_distinct_rev_codes	0.306	-0.158
rate_or	0.192	-0.292
avg_n_j_code_lines	0.163	-0.138
rate_transfusion	0.152	-0.378
avg_work_rvu	0.049	0.003
rate_multiple_or_days	0.000	0.241
avg_n_distinct_hcps	-0.040	0.152

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=33 codes)

code	Description	Score	N claims	Key drivers
BY4FZZZ	ULTRASONOGRAPHY OF THIRD TRIMESTER, SINGLE FETUS	0.240	1583	organ system count (+0.54), n j code lines (-0.28), n distinct rev codes (+0.20)
0JHF3HZ	INSERTION OF CONTRACEPTIVE DEVICE INTO LEFT UPPER ARM SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	0.085	3724	n j code lines (+0.12), or (+0.11), icu (-0.10)
10H07YZ	INSERTION OF OTHER DEVICE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	0.053	23803	n distinct rev codes (+0.14), relative claim charge (+0.10), length of stay (+0.10)
4A0HXCZ	MEASUREMENT OF PRODUCTS OF CONCEPTION, CARDIAC RATE, EXTERNAL APPROACH	0.049	4561	n imaging lines (+0.25), organ system count (+0.24), n j code lines (-0.15)
4A1H74Z	MONITORING OF PRODUCTS OF CONCEPTION, CARDIAC ELECTRICAL ACTIVITY, VIA NATURAL OR ARTIFICIAL OPENING	-0.043	1792	n j code lines (+0.25), icu (-0.11), dialysis (-0.09)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-0.047	2201	n imaging lines (-0.09), length of stay (+0.09), n j code lines (+0.08)
10H073Z	INSERTION OF MONITORING ELECTRODE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	-0.110	6703	icu (-0.11), n imaging lines (-0.11), n distinct rev codes (+0.08)
0U7C7DJ	None	-0.117	6277	relative claim charge (+0.13), length of stay (+0.12), n imaging lines (-0.10)
4A1H7CZ	MONITORING OF PRODUCTS OF CONCEPTION, CARDIAC RATE, VIA NATURAL OR ARTIFICIAL OPENING	-0.142	3838	icu (-0.11), n distinct rev codes (+0.10), n imaging lines (-0.10)
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-0.166	11474	organ system count (-0.10), length of stay (+0.10), n imaging lines (-0.08)

Tier 2 (n=6 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	4.924	6048	transfusion (+0.93), n distinct rev codes (+0.84), relative claim charge (+0.59)
3E0T3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	1.521	1774	n distinct rev codes (+0.51), or (+0.49), relative claim charge (+0.27)
0UH90HZ	INSERTION OF CONTRACEPTIVE DEVICE INTO UTERUS, OPEN APPROACH	1.468	2262	or (+0.48), n j code lines (+0.34), relative claim charge (+0.32)
0HB7XZZ	EXCISION OF ABDOMEN SKIN, EXTERNAL APPROACH	0.858	1085	organ system count (+0.43), or (+0.39), n j code lines (+0.25)
3E0E7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PRODUCTS OF CONCEPTION, VIA NATURAL OR ARTIFICIAL OPENING	0.677	1856	n j code lines (+0.49), n distinct rev codes (+0.23), work rvu (+0.19)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	0.640	1137	n imaging lines (+0.48), organ system count (+0.39), n distinct rev codes (-0.30)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	15.402	1165	dialysis (+2.08), icu (+2.06), mechanical ventilation (+2.06)

Key Driver Frequency

feature	count	pct
relative claim charge	18	45.000
organ system count	17	42.500
n distinct rev codes	17	42.500
n imaging lines	15	37.500
n j code lines	14	35.000
length of stay	14	35.000
or	12	30.000
icu	6	15.000
dialysis	3	7.500
work rvu	1	2.500
n distinct hcps	1	2.500
transfusion	1	2.500
mechanical ventilation	1	2.500