IP - PU.1.infection

CM Codes

Data Overview

14610 total codes in komodo_rii; 478 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	289
CC	133
MCC	56

PCA Analysis

PC1 explains 32.8% of variance; PC1+PC2 together explain 46.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	work rvu	n j code lines	or	n imaging lines	transfusion
1	279.000	2845309.000	6.273	15.866	1.013	0.435	0.382	0.085	0.866	0.042
2	164.000	944416.000	7.553	17.185	1.227	0.613	0.511	0.148	0.980	0.088
3	35.000	113273.000	9.492	18.221	1.582	0.884	0.747	0.275	1.026	0.141

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	58	53	22	133
MCC	8	40	8	56
No CC/MCC	213	71	5	289
All	279	164	35	478

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.426	-0.039	0.475
avg_length_of_stay	0.390	-0.093	0.364
avg_n_distinct_rev_codes	0.365	0.029	0.326
rate_or	0.332	-0.130	0.396
rate_multiple_or_days	0.314	-0.006	0.252
avg_n_j_code_lines	0.283	-0.089	0.303
rate_transfusion	0.278	0.054	0.419
rate_icu	0.241	0.065	0.396
avg_work_rvu	0.240	-0.098	0.234
avg_n_imaging_lines	0.201	-0.096	0.102
rate_mechanical_ventilation	0.061	0.382	0.114
rate_dialysis	0.055	0.198	0.217
avg_n_distinct_hcps	0.043	-0.104	-0.408
avg_organ_system_count	0.041	-0.060	-0.502

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	5.908	3	837	work rvu (+1.53), or (+0.91), multiple or days (+0.89)
B9561	Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere	No CC/MCC	3.627	3	1040	or (+1.17), relative claim charge (+0.69), length of stay (+0.62)
D500	Iron deficiency anemia secondary to blood loss (chronic)	No CC/MCC	3.514	3	1274	transfusion (+1.36), n distinct rev codes (+0.46), multiple or days (+0.41)
I4719	Other supraventricular tachycardia	No CC/MCC	3.459	3	1448	work rvu (+2.18), relative claim charge (+0.57), icu (+0.31)
B9562	Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere	No CC/MCC	3.273	3	1357	length of stay (+0.85), relative claim charge (+0.59), or (+0.58)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
U071	COVID-19	MCC	-3.118	1	256963	length of stay (-0.54), n distinct rev codes (-0.52), relative claim charge (-0.50)
A481	Legionnaires' disease	MCC	-1.285	1	1485	relative claim charge (-0.42), length of stay (-0.41), multiple or days (-0.30)
J159	Unspecified bacterial pneumonia	MCC	-0.750	1	20197	multiple or days (-0.25), or (-0.15), work rvu (-0.10)
J9601	Acute respiratory failure with hypoxia	MCC	-0.673	1	148320	length of stay (-0.22), icu (+0.16), or (-0.13)
G800	Spastic quadriplegic cerebral palsy	MCC	-0.482	1	1457	n distinct rev codes (-0.63), relative claim charge (+0.44), n imaging lines (-0.40)

Top Codes by Tier

Tier 1 (n=279 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E861	Hypovolemia	No CC/MCC	-0.093	6871	multiple or days (+0.23), relative claim charge (-0.20), or (-0.14)
N200	Calculus of kidney	No CC/MCC	-0.099	1465	n imaging lines (+0.26), icu (-0.17), multiple or days (+0.12)
T380X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter	No CC/MCC	-0.114	7512	or (-0.21), n j code lines (+0.20), icu (+0.19)
E8721	Acute metabolic acidosis	No CC/MCC	-0.119	2057	multiple or days (-0.30), n distinct rev codes (+0.23), n j code lines (-0.22)
C3411	Malignant neoplasm of upper lobe, right bronchus or lung	CC	-0.132	1326	n j code lines (-0.33), multiple or days (-0.30), transfusion (+0.18)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	-0.138	1661	n imaging lines (+0.28), n j code lines (-0.22), length of stay (-0.21)
F410	Panic disorder [episodic paroxysmal anxiety]	No CC/MCC	-0.144	1217	multiple or days (+0.19), n distinct rev codes (-0.19), transfusion (-0.14)
J158	Pneumonia due to other specified bacteria	MCC	-0.162	2893	work rvu (-0.15), or (+0.14), icu (+0.10)
E042	Nontoxic multinodular goiter	No CC/MCC	-0.162	917	n imaging lines (+0.37), length of stay (-0.21), relative claim charge (+0.21)
I080	Rheumatic disorders of both mitral and aortic valves	No CC/MCC	-0.167	1808	icu (+0.22), multiple or days (-0.21), n distinct rev codes (+0.20)

Tier 2 (n=164 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	3.030	16419	icu (+1.01), relative claim charge (+0.95), n distinct rev codes (+0.46)
G931	Anoxic brain damage, not elsewhere classified	CC	3.011	1237	relative claim charge (+0.81), multiple or days (+0.70), length of stay (+0.56)
L89153	Pressure ulcer of sacral region, stage 3	MCC	2.922	2346	length of stay (+0.91), relative claim charge (+0.56), n distinct rev codes (+0.46)
J9690	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	MCC	2.912	1266	work rvu (+0.73), icu (+0.60), length of stay (+0.46)
E8770	Fluid overload, unspecified	No CC/MCC	2.849	3276	relative claim charge (+0.52), icu (+0.38), work rvu (+0.38)
I2693	Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale	MCC	2.839	1131	relative claim charge (+0.75), n distinct rev codes (+0.61), length of stay (+0.46)
J15211	Pneumonia due to Methicillin susceptible Staphylococcus aureus	MCC	2.815	3171	relative claim charge (+0.87), multiple or days (+0.52), or (+0.51)
D61810	Antineoplastic chemotherapy induced pancytopenia	MCC	2.721	2031	transfusion (+2.00), relative claim charge (+0.29), n distinct rev codes (+0.22)
J13	Pneumonia due to Streptococcus pneumoniae	MCC	2.718	1038	multiple or days (+0.86), n j code lines (+0.56), relative claim charge (+0.51)
N136	Pyonephrosis	CC	2.701	923	multiple or days (+0.72), length of stay (+0.47), n distinct rev codes (+0.42)

Tier 3 (n=35 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J80	Acute respiratory distress syndrome	MCC	9.865	1685	relative claim charge (+3.05), length of stay (+1.56), icu (+1.39)
D62	Acute posthemorrhagic anemia	CC	8.325	5515	transfusion (+2.53), relative claim charge (+1.47), n distinct rev codes (+1.14)
B59	Pneumocystosis	MCC	8.325	1260	multiple or days (+1.81), n j code lines (+1.38), relative claim charge (+1.35)
J939	Pneumothorax, unspecified	CC	7.587	926	relative claim charge (+1.29), or (+1.25), n j code lines (+1.19)
J948	Other specified pleural conditions	CC	7.437	1414	or (+1.80), relative claim charge (+1.43), length of stay (+1.11)
J869	Pyothorax without fistula	MCC	6.663	6720	or (+1.96), multiple or days (+1.41), relative claim charge (+1.01)
J860	Pyothorax with fistula	MCC	6.624	1165	or (+1.67), relative claim charge (+1.22), n j code lines (+1.11)
A419	Sepsis, unspecified organism	MCC	6.570	8526	relative claim charge (+1.22), work rvu (+1.15), length of stay (+1.01)
N170	Acute kidney failure with tubular necrosis	MCC	6.300	5653	relative claim charge (+1.44), length of stay (+0.97), n distinct rev codes (+0.91)
E874	Mixed disorder of acid-base balance	CC	6.289	2586	relative claim charge (+1.56), multiple or days (+1.18), icu (+0.92)

Key Driver Frequency

feature	count	pct
relative claim charge	290	60.700
length of stay	229	47.900
n distinct rev codes	193	40.400
multiple or days	155	32.400
or	148	31.000
n j code lines	125	26.200
icu	102	21.300
work rvu	66	13.800
transfusion	56	11.700
n imaging lines	55	11.500
mechanical ventilation	7	1.500
dialysis	6	1.300
n distinct hcps	2	0.400

PCS Codes

Data Overview

2815 total codes in komodo_rii; 59 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 36.5% of variance; PC1+PC2 together explain 51.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	or	n imaging lines	icu	dialysis
1	14.000	182520.000	14.565	5.933	1.067	4.741	0.068	0.845	0.268	0.028
2	15.000	65559.000	18.042	7.596	1.541	4.911	0.183	1.050	0.453	0.089
3	28.000	65296.000	20.471	10.400	1.928	5.183	0.488	1.137	0.420	0.051
4	2.000	2278.000	22.559	12.453	2.737	5.871	0.616	1.203	0.614	0.330

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.399	-0.121
avg_length_of_stay	0.392	-0.054
avg_relative_claim_charge	0.387	-0.117
rate_or	0.343	-0.079
avg_organ_system_count	0.307	-0.096
rate_multiple_or_days	0.275	0.041
rate_transfusion	0.234	0.024
avg_n_distinct_hcps	0.201	-0.151
rate_icu	0.200	-0.052
avg_n_imaging_lines	0.190	-0.337
avg_work_rvu	0.183	0.039
rate_mechanical_ventilation	0.149	0.270
rate_dialysis	0.111	0.133
avg_n_j_code_lines	0.103	-0.023

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=14 codes)

code	Description	Score	N claims	Key drivers
XW043E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	-2.179	1604	n distinct rev codes (-0.44), relative claim charge (-0.41), length of stay (-0.40)
XW0DXF5	INTRODUCTION OF OTHER NEW TECHNOLOGY THERAPEUTIC SUBSTANCE INTO MOUTH AND PHARYNX, EXTERNAL APPROACH, NEW TECHNOLOGY GROUP 5	-2.237	1532	work rvu (+0.89), relative claim charge (-0.78), length of stay (-0.70)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-2.352	1129	length of stay (-0.38), relative claim charge (-0.37), n distinct hcps (-0.33)
B32S1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF RIGHT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-2.589	849	n distinct rev codes (-0.62), relative claim charge (-0.41), length of stay (-0.40)
B32T1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF LEFT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-2.639	849	n distinct rev codes (-0.60), length of stay (-0.39), organ system count (-0.38)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-2.974	937	relative claim charge (-0.54), n distinct rev codes (-0.39), length of stay (-0.39)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.996	2792	relative claim charge (-0.49), n distinct rev codes (-0.49), length of stay (-0.43)
3E0333Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.238	19013	length of stay (-0.57), n distinct rev codes (-0.55), relative claim charge (-0.53)
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-3.244	4292	relative claim charge (-0.49), length of stay (-0.46), n distinct rev codes (-0.39)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.448	857	n distinct rev codes (-0.56), length of stay (-0.54), relative claim charge (-0.53)

Tier 2 (n=15 codes)

code	Description	Score	N claims	Key drivers
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	0.158	2078	n distinct hcps (-0.29), or (+0.26), length of stay (+0.15)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.306	11742	dialysis (+0.69), organ system count (+0.39), relative claim charge (-0.30)
0CJS8ZZ	INSPECTION OF LARYNX, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-0.334	880	multiple or days (-0.16), work rvu (+0.13), n imaging lines (+0.10)
4A03X5D	MEASUREMENT OF ARTERIAL FLOW, INTRACRANIAL, EXTERNAL APPROACH	-0.775	876	n imaging lines (+0.86), length of stay (-0.42), or (-0.36)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.855	1462	or (-0.28), length of stay (-0.26), n distinct rev codes (+0.24)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-0.933	7486	icu (+0.32), or (-0.28), organ system count (-0.22)
5A0945A	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-1.021	4857	organ system count (-0.36), icu (+0.36), or (-0.26)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.074	4286	icu (+0.36), or (-0.27), multiple or days (-0.24)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.139	22302	or (-0.28), length of stay (-0.24), icu (+0.22)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-1.216	2685	n distinct hcps (-0.30), relative claim charge (-0.29), or (-0.28)

Tier 3 (n=28 codes)

code	Description	Score	N claims	Key drivers
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.945	859	icu (+0.53), organ system count (+0.51), relative claim charge (+0.48)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	2.547	3595	length of stay (+0.82), n distinct rev codes (+0.56), relative claim charge (+0.38)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.491	8044	transfusion (+1.52), organ system count (+0.44), n distinct rev codes (+0.23)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.437	1432	multiple or days (+0.89), or (+0.51), n distinct rev codes (+0.37)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	2.361	8455	or (+0.49), length of stay (+0.45), relative claim charge (+0.37)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.218	1057	n distinct rev codes (+0.64), organ system count (+0.54), multiple or days (+0.25)
0W9930Z	DRAINAGE OF RIGHT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	2.185	3416	or (+0.48), multiple or days (+0.47), length of stay (+0.36)
3E0L3GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PLEURAL CAVITY, PERCUTANEOUS APPROACH	2.171	1663	or (+0.48), length of stay (+0.41), n distinct hcps (+0.35)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.003	2328	n distinct rev codes (+0.46), organ system count (+0.46), transfusion (+0.31)
0DH67UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, VIA NATURAL OR ARTIFICIAL OPENING	1.908	905	length of stay (+0.64), relative claim charge (+0.44), multiple or days (-0.30)

Tier 4 (n=2 codes)

code	Description	Score	N claims	Key drivers
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	5.591	1063	length of stay (+1.02), relative claim charge (+0.88), n distinct rev codes (+0.73)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	5.232	1215	mechanical ventilation (+1.07), relative claim charge (+0.97), organ system count (+0.91)

Key Driver Frequency

feature	count	pct
length of stay	33	55.900
n distinct rev codes	30	50.800
or	28	47.500
relative claim charge	27	45.800
multiple or days	15	25.400
organ system count	14	23.700
n distinct hcps	9	15.300
icu	8	13.600
work rvu	4	6.800
n imaging lines	4	6.800
transfusion	3	5.100
mechanical ventilation	1	1.700
dialysis	1	1.700