IP - PU.1.copd

CM Codes

Data Overview

10168 total codes in komodo_rii; 383 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	254
CC	97
MCC	32

PCA Analysis

PC1 explains 32.5% of variance; PC1+PC2 together explain 43.9%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	n j code lines	work rvu	n imaging lines	icu	or
1	209.000	1670530.000	4.569	14.636	1.014	0.441	0.414	0.563	0.248	0.033
2	147.000	545087.000	5.253	15.592	1.172	0.543	0.525	0.688	0.293	0.053
3	27.000	40652.000	6.821	16.887	1.430	0.796	0.761	0.835	0.342	0.111

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	42	43	12	97
MCC	6	20	6	32
No CC/MCC	161	84	9	254
All	209	147	27	383

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.414	-0.168	0.389
avg_n_distinct_rev_codes	0.397	-0.154	0.248
avg_length_of_stay	0.358	-0.146	0.336
rate_or	0.328	-0.199	0.267
avg_n_imaging_lines	0.303	-0.275	0.127
rate_transfusion	0.278	0.006	0.289
rate_multiple_or_days	0.252	0.196	0.057
avg_work_rvu	0.250	-0.066	0.222
avg_n_j_code_lines	0.242	-0.016	0.140
rate_icu	0.242	0.119	0.265
avg_n_distinct_hcps	0.150	-0.170	-0.149
rate_dialysis	0.021	0.068	0.290
avg_organ_system_count	0.002	-0.119	-0.494
rate_mechanical_ventilation	0.002	0.345	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
J9809	Other diseases of bronchus, not elsewhere classified	No CC/MCC	6.699	3	595	or (+1.98), multiple or days (+1.38), relative claim charge (+0.89)
M6281	Muscle weakness (generalized)	No CC/MCC	5.951	3	781	length of stay (+3.98), n distinct rev codes (+1.65), work rvu (+0.63)
J1569	Pneumonia due to other Gram-negative bacteria	No CC/MCC	5.649	3	819	relative claim charge (+1.43), multiple or days (+1.03), length of stay (+0.88)
G928	Other toxic encephalopathy	No CC/MCC	5.415	3	2029	relative claim charge (+1.40), n distinct rev codes (+1.15), icu (+1.09)
D84821	Immunodeficiency due to drugs	No CC/MCC	4.788	3	1192	multiple or days (+1.65), n j code lines (+1.48), work rvu (+0.88)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J9601	Acute respiratory failure with hypoxia	MCC	-1.644	1	64111	relative claim charge (-0.37), length of stay (-0.33), n distinct rev codes (-0.24)
J1000	Influenza due to other identified influenza virus with unspecified type of pneumonia	MCC	-1.473	1	833	n distinct hcps (-0.33), n distinct rev codes (-0.29), or (-0.18)
J129	Viral pneumonia, unspecified	MCC	-1.418	1	912	relative claim charge (-0.20), length of stay (-0.20), icu (-0.19)
J9691	Respiratory failure, unspecified with hypoxia	MCC	-1.201	1	1424	relative claim charge (-0.51), n distinct rev codes (-0.38), length of stay (-0.32)
J9620	Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-0.609	1	2298	n imaging lines (-0.30), relative claim charge (-0.28), work rvu (+0.24)

Top Codes by Tier

Tier 1 (n=209 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I442	Atrioventricular block, complete	CC	-0.216	582	n imaging lines (-0.13), multiple or days (+0.12), length of stay (-0.11)
F0393	Unspecified dementia, unspecified severity, with mood disturbance	No CC/MCC	-0.258	992	length of stay (+0.28), n distinct rev codes (+0.18), n j code lines (-0.16)
E860	Dehydration	No CC/MCC	-0.260	6414	n distinct rev codes (+0.20), n imaging lines (+0.15), work rvu (-0.15)
I350	Nonrheumatic aortic (valve) stenosis	No CC/MCC	-0.282	2717	n distinct rev codes (+0.14), relative claim charge (-0.12), n j code lines (-0.10)
E041	Nontoxic single thyroid nodule	No CC/MCC	-0.290	933	n imaging lines (+0.61), n j code lines (-0.35), work rvu (-0.30)
J4551	Severe persistent asthma with (acute) exacerbation	CC	-0.315	1633	n distinct rev codes (-0.39), n imaging lines (-0.32), n j code lines (+0.32)
F0390	Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety	No CC/MCC	-0.323	3929	relative claim charge (-0.29), n distinct rev codes (+0.22), or (-0.19)
U071	COVID-19	MCC	-0.353	2252	work rvu (+0.34), n distinct rev codes (-0.33), length of stay (+0.24)
E871	Hypo-osmolality and hyponatremia	CC	-0.361	24348	n distinct hcps (-0.12), work rvu (-0.10), multiple or days (-0.08)
I7121	Aneurysm of the ascending aorta, without rupture	No CC/MCC	-0.375	883	n imaging lines (+0.44), work rvu (-0.22), length of stay (-0.22)

Tier 2 (n=147 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K766	Portal hypertension	CC	3.172	554	or (+0.74), n distinct rev codes (+0.68), n imaging lines (+0.53)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	3.139	1451	relative claim charge (+0.89), length of stay (+0.77), n distinct rev codes (+0.62)
N200	Calculus of kidney	No CC/MCC	2.873	615	n imaging lines (+0.75), work rvu (+0.50), n j code lines (+0.48)
B370	Candidal stomatitis	CC	2.809	2510	relative claim charge (+1.06), length of stay (+0.95), n distinct rev codes (+0.40)
D61818	Other pancytopenia	CC	2.717	1143	transfusion (+1.05), relative claim charge (+0.52), n distinct rev codes (+0.49)
M4856XA	Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture	CC	2.689	511	n imaging lines (+1.25), n distinct rev codes (+0.58), work rvu (+0.39)
I959	Hypotension, unspecified	No CC/MCC	2.631	4481	n j code lines (+0.60), n distinct rev codes (+0.38), icu (+0.38)
I491	Atrial premature depolarization	No CC/MCC	2.471	511	multiple or days (+1.10), work rvu (+0.68), n j code lines (+0.40)
I5043	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure	MCC	2.467	2284	relative claim charge (+0.62), n distinct rev codes (+0.54), length of stay (+0.48)
D6959	Other secondary thrombocytopenia	No CC/MCC	2.390	595	transfusion (+0.50), relative claim charge (+0.41), multiple or days (+0.37)

Tier 3 (n=27 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D62	Acute posthemorrhagic anemia	CC	14.176	1304	transfusion (+3.93), n distinct rev codes (+1.84), relative claim charge (+1.80)
N170	Acute kidney failure with tubular necrosis	MCC	8.384	822	relative claim charge (+1.97), n distinct rev codes (+1.45), length of stay (+1.17)
K921	Melena	CC	7.340	662	transfusion (+1.49), multiple or days (+1.22), n distinct rev codes (+0.90)
J9809	Other diseases of bronchus, not elsewhere classified	No CC/MCC	6.699	595	or (+1.98), multiple or days (+1.38), relative claim charge (+0.89)
J151	Pneumonia due to Pseudomonas	MCC	6.351	1157	length of stay (+1.79), relative claim charge (+1.70), or (+1.26)
J918	Pleural effusion in other conditions classified elsewhere	CC	6.316	634	or (+2.53), n distinct rev codes (+1.06), relative claim charge (+1.03)
J690	Pneumonitis due to inhalation of food and vomit	MCC	6.300	2661	relative claim charge (+1.35), n distinct rev codes (+1.13), length of stay (+0.92)
G9340	Encephalopathy, unspecified	CC	6.132	1606	relative claim charge (+1.08), n distinct rev codes (+1.06), n imaging lines (+0.97)
M6281	Muscle weakness (generalized)	No CC/MCC	5.951	781	length of stay (+3.98), n distinct rev codes (+1.65), work rvu (+0.63)
A419	Sepsis, unspecified organism	MCC	5.928	1675	n j code lines (+1.25), relative claim charge (+0.90), n distinct rev codes (+0.82)

Key Driver Frequency

feature	count	pct
relative claim charge	224	58.500
n distinct rev codes	223	58.200
length of stay	141	36.800
n imaging lines	130	33.900
work rvu	88	23.000
icu	82	21.400
or	74	19.300
n j code lines	70	18.300
multiple or days	60	15.700
n distinct hcps	39	10.200
transfusion	18	4.700

PCS Codes

Data Overview

1750 total codes in komodo_rii; 33 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 42.2% of variance; PC1+PC2 together explain 55.3%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	n j code lines	relative claim charge	work rvu	or	organ system count	n imaging lines
1	7.000	11399.000	13.304	4.519	0.381	1.013	0.184	0.022	4.612	0.545
2	10.000	42185.000	14.898	4.919	0.509	1.214	0.338	0.059	4.802	0.675
3	7.000	11377.000	17.026	6.000	0.616	1.668	0.559	0.101	4.697	0.642
4	8.000	6769.000	19.021	7.445	0.894	1.830	0.623	0.415	4.932	0.826
5	1.000	1403.000	19.154	9.006	1.892	2.182	1.381	0.590	5.166	0.853

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.363	-0.111
rate_multiple_or_days	0.363	-0.142
avg_length_of_stay	0.357	-0.159
avg_n_distinct_rev_codes	0.352	-0.083
avg_work_rvu	0.328	-0.138
rate_or	0.320	-0.242
avg_n_j_code_lines	0.318	-0.047
avg_n_imaging_lines	0.232	-0.478
avg_n_distinct_hcps	0.205	-0.355
rate_transfusion	0.170	-0.042
avg_organ_system_count	0.164	0.261
rate_icu	0.117	0.321
rate_dialysis	-0.001	0.202
rate_mechanical_ventilation	-0.098	0.330

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=7 codes)

code	Description	Score	N claims	Key drivers
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.418	650	relative claim charge (-0.41), n distinct rev codes (-0.39), work rvu (-0.38)
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-2.427	3845	relative claim charge (-0.45), n distinct hcps (-0.40), n distinct rev codes (-0.34)
3E013GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO SUBCUTANEOUS TISSUE, PERCUTANEOUS APPROACH	-2.669	550	relative claim charge (-0.51), n distinct rev codes (-0.44), length of stay (-0.40)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.673	1449	n distinct rev codes (-0.42), relative claim charge (-0.41), work rvu (-0.38)
3E0333Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.760	1416	relative claim charge (-0.45), n distinct rev codes (-0.41), length of stay (-0.32)
3E0F7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-2.891	1457	n distinct rev codes (-0.57), relative claim charge (-0.42), work rvu (-0.39)
8E0ZXY6	ISOLATION	-3.153	2032	mechanical ventilation (-0.55), n distinct rev codes (-0.41), relative claim charge (-0.38)

Tier 2 (n=10 codes)

code	Description	Score	N claims	Key drivers
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.842	4629	icu (+0.24), n imaging lines (-0.21), or (-0.18)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.866	2135	organ system count (+0.38), n imaging lines (-0.32), n j code lines (-0.22)
HZ2ZZZZ	DETOXIFICATION SERVICES FOR SUBSTANCE ABUSE TREATMENT	-1.051	680	relative claim charge (-0.33), length of stay (-0.28), multiple or days (-0.22)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-1.108	1759	n distinct hcps (-0.27), length of stay (-0.18), or (-0.16)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-1.349	860	relative claim charge (-0.48), length of stay (-0.26), n j code lines (+0.26)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.382	29621	n imaging lines (-0.24), length of stay (-0.24), relative claim charge (-0.20)
B32S1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF RIGHT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-1.478	633	n imaging lines (+0.52), n distinct rev codes (-0.37), length of stay (-0.33)
4A033R1	MEASUREMENT OF ARTERIAL SATURATION, PERIPHERAL, PERCUTANEOUS APPROACH	-1.607	609	work rvu (-0.37), n j code lines (-0.30), n distinct hcps (-0.27)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-1.655	677	n distinct hcps (-0.28), relative claim charge (-0.27), length of stay (-0.25)
B32T1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF LEFT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-1.863	582	n imaging lines (+0.49), n distinct rev codes (-0.41), length of stay (-0.32)

Tier 3 (n=7 codes)

code	Description	Score	N claims	Key drivers
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	0.580	503	work rvu (+0.73), length of stay (+0.40), multiple or days (-0.22)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	0.432	3527	work rvu (+0.27), n j code lines (+0.25), icu (+0.21)
5A0945A	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	0.398	1454	multiple or days (-0.22), work rvu (+0.22), icu (+0.21)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	0.284	625	n distinct hcps (-0.51), or (+0.39), length of stay (+0.28)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	0.156	2357	n distinct rev codes (+0.37), relative claim charge (+0.36), multiple or days (-0.22)
B2151ZZ	FLUOROSCOPY OF LEFT HEART USING LOW OSMOLAR CONTRAST	-0.382	1045	n distinct rev codes (+0.38), relative claim charge (+0.34), work rvu (-0.25)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	-0.429	1866	n distinct rev codes (+0.34), relative claim charge (+0.30), length of stay (-0.25)

Tier 4 (n=8 codes)

code	Description	Score	N claims	Key drivers
0B9J8ZX	DRAINAGE OF LEFT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	4.016	504	n j code lines (+0.97), multiple or days (+0.85), or (+0.71)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	3.601	523	or (+0.72), work rvu (+0.63), multiple or days (+0.56)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	3.528	645	multiple or days (+0.63), n distinct rev codes (+0.58), length of stay (+0.50)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.121	2042	transfusion (+0.88), multiple or days (+0.51), n distinct rev codes (+0.37)
0B9F8ZX	DRAINAGE OF RIGHT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.981	602	or (+0.76), multiple or days (+0.47), length of stay (+0.41)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.636	828	n distinct rev codes (+0.66), organ system count (+0.44), n imaging lines (+0.40)
5A09557	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	2.236	1089	length of stay (+1.01), relative claim charge (+0.72), work rvu (+0.33)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	2.203	536	or (+0.62), n distinct rev codes (+0.49), n distinct hcps (+0.31)

Tier 5 (n=1 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	6.829	1403	multiple or days (+1.17), n j code lines (+1.06), work rvu (+1.06)

Key Driver Frequency

feature	count	pct
n distinct rev codes	16	48.500
relative claim charge	15	45.500
length of stay	15	45.500
work rvu	11	33.300
multiple or days	10	30.300
or	7	21.200
n imaging lines	6	18.200
n j code lines	6	18.200
n distinct hcps	6	18.200
icu	3	9.100
organ system count	2	6.100
transfusion	1	3.000
mechanical ventilation	1	3.000