IP - PU.1.pneumonia

CM Codes

Data Overview

14673 total codes in komodo_rii; 452 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	284
CC	118
MCC	50

PCA Analysis

PC1 explains 35.6% of variance; PC1+PC2 together explain 51.7%.

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	work rvu	n j code lines	or
1	48.000	520484.000	13.203	4.083	4.383	0.927	0.501	0.339	0.429	0.041
2	262.000	3484928.000	15.792	5.273	5.707	1.072	0.840	0.423	0.392	0.069
3	134.000	815650.000	16.897	6.258	5.677	1.276	0.960	0.556	0.466	0.115
4	8.000	21187.000	18.704	8.212	5.517	1.879	1.014	0.842	0.762	0.243

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	10	54	49	5	118
MCC	7	19	21	3	50
No CC/MCC	31	189	64	0	284
All	48	262	134	8	452

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.391	-0.048	0.335
avg_n_distinct_rev_codes	0.379	-0.039	0.198
avg_length_of_stay	0.366	-0.078	0.223
rate_or	0.337	-0.089	0.283
rate_multiple_or_days	0.291	0.063	0.215
avg_n_imaging_lines	0.276	-0.201	-0.004
rate_transfusion	0.262	0.004	0.289
avg_work_rvu	0.246	-0.088	0.190
rate_icu	0.238	0.156	0.328
avg_n_j_code_lines	0.190	0.009	0.275
rate_mechanical_ventilation	0.158	0.397	0.214
avg_n_distinct_hcps	0.144	-0.194	-0.301
avg_organ_system_count	0.144	-0.143	-0.449
rate_dialysis	0.077	0.168	0.218

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (0 codes)

None.

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J157	Pneumonia due to Mycoplasma pneumoniae	MCC	-4.978	1	9246	n distinct rev codes (-1.11), length of stay (-0.69), n imaging lines (-0.69)
J129	Viral pneumonia, unspecified	MCC	-3.960	1	12983	n distinct rev codes (-0.77), length of stay (-0.57), relative claim charge (-0.56)
J120	Adenoviral pneumonia	MCC	-2.827	1	1037	n distinct rev codes (-0.82), n imaging lines (-0.58), length of stay (-0.42)
J1000	Influenza due to other identified influenza virus with unspecified type of pneumonia	MCC	-2.541	1	19069	n distinct rev codes (-0.36), or (-0.34), relative claim charge (-0.33)
J123	Human metapneumovirus pneumonia	MCC	-2.468	1	9124	n distinct rev codes (-0.49), n imaging lines (-0.45), or (-0.32)

Top Codes by Tier

Tier 1 (n=48 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-2.121	50918	length of stay (-0.45), relative claim charge (-0.35), n distinct rev codes (-0.24)
F1110	Opioid abuse, uncomplicated	No CC/MCC	-2.147	1386	relative claim charge (-0.56), length of stay (-0.54), n distinct rev codes (-0.35)
I10	Essential (primary) hypertension	No CC/MCC	-2.171	152695	relative claim charge (-0.47), length of stay (-0.38), n distinct rev codes (-0.26)
J1008	Influenza due to other identified influenza virus with other specified pneumonia	MCC	-2.210	13407	n distinct rev codes (-0.36), n imaging lines (-0.32), n distinct hcps (-0.30)
F88	Other disorders of psychological development	No CC/MCC	-2.259	1443	n distinct rev codes (-1.25), n imaging lines (-1.03), relative claim charge (+0.88)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	-2.263	4030	length of stay (-0.53), relative claim charge (-0.45), n distinct rev codes (-0.25)
J309	Allergic rhinitis, unspecified	No CC/MCC	-2.268	1567	relative claim charge (-0.48), n distinct rev codes (-0.47), length of stay (-0.37)
B348	Other viral infections of unspecified site	No CC/MCC	-2.283	3391	n distinct rev codes (-0.73), n imaging lines (-0.54), length of stay (-0.51)
J121	Respiratory syncytial virus pneumonia	MCC	-2.311	12648	n distinct rev codes (-0.55), n imaging lines (-0.51), or (-0.32)
J123	Human metapneumovirus pneumonia	MCC	-2.468	9124	n distinct rev codes (-0.49), n imaging lines (-0.45), or (-0.32)

Tier 2 (n=262 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N281	Cyst of kidney, acquired	No CC/MCC	0.666	1869	n imaging lines (+0.48), n distinct rev codes (+0.29), multiple or days (-0.26)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	0.642	8990	dialysis (+0.71), length of stay (-0.24), transfusion (+0.24)
C3490	Malignant neoplasm of unspecified part of unspecified bronchus or lung	CC	0.639	6624	n imaging lines (+0.26), work rvu (+0.24), or (+0.22)
M48061	Spinal stenosis, lumbar region without neurogenic claudication	No CC/MCC	0.635	1632	n imaging lines (+0.56), n distinct rev codes (+0.30), length of stay (+0.30)
L03116	Cellulitis of left lower limb	CC	0.626	2272	n distinct rev codes (+0.43), length of stay (+0.40), multiple or days (-0.26)
I081	Rheumatic disorders of both mitral and tricuspid valves	No CC/MCC	0.586	2826	icu (+0.33), n distinct rev codes (+0.28), n j code lines (-0.28)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	0.579	8975	work rvu (+0.72), n j code lines (+0.30), multiple or days (+0.23)
I21A1	Myocardial infarction type 2	MCC	0.576	15321	icu (+0.38), relative claim charge (+0.23), n distinct rev codes (+0.22)
D6859	Other primary thrombophilia	CC	0.547	1222	mechanical ventilation (+0.29), n imaging lines (+0.16), multiple or days (+0.14)
D509	Iron deficiency anemia, unspecified	No CC/MCC	0.537	21056	transfusion (+0.34), n distinct rev codes (+0.11), organ system count (+0.09)

Tier 3 (n=134 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J918	Pleural effusion in other conditions classified elsewhere	CC	4.997	12592	or (+2.32), relative claim charge (+0.59), multiple or days (+0.59)
K921	Melena	CC	4.894	1628	transfusion (+0.99), work rvu (+0.97), multiple or days (+0.74)
J690	Pneumonitis due to inhalation of food and vomit	MCC	4.791	4244	relative claim charge (+0.91), length of stay (+0.88), work rvu (+0.77)
M6281	Muscle weakness (generalized)	No CC/MCC	4.527	2788	length of stay (+3.25), n distinct rev codes (+1.22), n j code lines (-0.35)
E870	Hyperosmolality and hypernatremia	CC	4.513	8078	length of stay (+1.14), relative claim charge (+1.04), n distinct rev codes (+0.59)
G9340	Encephalopathy, unspecified	CC	4.417	5880	n imaging lines (+0.72), work rvu (+0.71), length of stay (+0.62)
D689	Coagulation defect, unspecified	CC	4.377	1807	multiple or days (+0.80), or (+0.77), relative claim charge (+0.64)
L89153	Pressure ulcer of sacral region, stage 3	MCC	4.237	1516	length of stay (+1.13), multiple or days (+0.71), relative claim charge (+0.52)
J9809	Other diseases of bronchus, not elsewhere classified	No CC/MCC	4.082	1094	or (+1.39), work rvu (+0.91), relative claim charge (+0.47)
G928	Other toxic encephalopathy	No CC/MCC	3.939	8911	n imaging lines (+0.88), n distinct rev codes (+0.69), length of stay (+0.64)

Tier 4 (n=8 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J80	Acute respiratory distress syndrome	MCC	15.092	1199	relative claim charge (+2.94), mechanical ventilation (+2.84), n j code lines (+2.01)
J869	Pyothorax without fistula	MCC	11.128	1852	or (+3.32), multiple or days (+2.03), relative claim charge (+1.93)
D62	Acute posthemorrhagic anemia	CC	9.385	4998	transfusion (+2.32), relative claim charge (+1.42), n distinct rev codes (+1.23)
K567	Ileus, unspecified	CC	7.610	1522	relative claim charge (+1.61), multiple or days (+1.27), work rvu (+1.19)
N170	Acute kidney failure with tubular necrosis	MCC	7.505	4546	relative claim charge (+1.57), length of stay (+1.14), n distinct rev codes (+1.07)
E874	Mixed disorder of acid-base balance	CC	6.076	3356	relative claim charge (+1.53), icu (+0.93), length of stay (+0.86)
K922	Gastrointestinal hemorrhage, unspecified	CC	5.903	1559	transfusion (+1.64), relative claim charge (+0.90), length of stay (+0.79)
J910	Malignant pleural effusion	CC	5.876	2155	or (+2.07), multiple or days (+1.56), n distinct rev codes (+0.50)

Key Driver Frequency

feature	count	pct
relative claim charge	219	48.500
n distinct rev codes	178	39.400
length of stay	178	39.400
multiple or days	139	30.800
or	124	27.400
icu	111	24.600
n imaging lines	93	20.600
work rvu	86	19.000
n j code lines	65	14.400
n distinct hcps	53	11.700
transfusion	48	10.600
organ system count	41	9.100
mechanical ventilation	13	2.900
dialysis	8	1.800

PCS Codes

Data Overview

2720 total codes in komodo_rii; 46 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 32.7% of variance; PC1+PC2 together explain 49.1%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	organ system count	or	n imaging lines	work rvu	icu
1	4.000	20629.000	13.354	4.648	1.022	4.352	0.043	0.679	0.200	0.193
2	10.000	62986.000	15.490	5.499	1.318	4.488	0.086	0.807	0.392	0.425
3	10.000	33494.000	18.046	6.507	1.651	4.963	0.163	0.903	0.477	0.397
4	15.000	39135.000	19.172	7.998	1.899	4.866	0.477	1.039	0.477	0.391
5	7.000	15576.000	20.666	8.586	2.113	5.001	0.551	1.096	0.566	0.365

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.408	-0.064
avg_length_of_stay	0.387	-0.180
rate_or	0.366	-0.186
avg_relative_claim_charge	0.363	-0.081
rate_multiple_or_days	0.309	-0.183
avg_n_imaging_lines	0.296	-0.385
avg_organ_system_count	0.245	-0.217
avg_work_rvu	0.239	-0.115
avg_n_distinct_hcps	0.227	0.042
rate_transfusion	0.200	0.037
avg_n_j_code_lines	0.130	-0.093
rate_icu	0.090	0.129
rate_dialysis	0.031	0.252
rate_mechanical_ventilation	0.009	0.267

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=4 codes)

code	Description	Score	N claims	Key drivers
3E0F7SF	INTRODUCTION OF OTHER GAS INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-3.742	5817	length of stay (-0.54), relative claim charge (-0.52), n distinct rev codes (-0.51)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.889	5324	n distinct rev codes (-0.65), length of stay (-0.61), relative claim charge (-0.57)
8E0ZXY6	ISOLATION	-3.982	7590	n distinct rev codes (-0.78), length of stay (-0.56), relative claim charge (-0.55)
3E0F7GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO RESPIRATORY TRACT, VIA NATURAL OR ARTIFICIAL OPENING	-4.077	1898	n distinct rev codes (-1.05), n imaging lines (-0.59), relative claim charge (-0.50)

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	-1.429	6495	n imaging lines (-0.37), or (-0.32), icu (+0.20)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-1.625	32230	or (-0.33), n imaging lines (-0.28), length of stay (-0.25)
B32S1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF RIGHT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-1.864	1232	n distinct rev codes (-0.56), length of stay (-0.48), relative claim charge (-0.48)
5A0935A	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-2.093	9519	organ system count (-0.42), n imaging lines (-0.39), n distinct rev codes (-0.38)
B246ZZZ	ULTRASONOGRAPHY OF RIGHT AND LEFT HEART	-2.141	1752	n distinct rev codes (-0.41), relative claim charge (-0.37), or (-0.33)
B32T1ZZ	COMPUTERIZED TOMOGRAPHY (CT SCAN) OF LEFT PULMONARY ARTERY USING LOW OSMOLAR CONTRAST	-2.173	1178	n distinct rev codes (-0.61), length of stay (-0.50), relative claim charge (-0.47)
5A0945A	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	-2.431	6774	organ system count (-0.65), n imaging lines (-0.58), n distinct rev codes (-0.49)
4A033R1	MEASUREMENT OF ARTERIAL SATURATION, PERIPHERAL, PERCUTANEOUS APPROACH	-2.574	1260	work rvu (-0.51), length of stay (-0.39), n distinct hcps (-0.38)
3E0333Z	INTRODUCTION OF ANTI-INFLAMMATORY INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.775	1217	n distinct rev codes (-0.48), length of stay (-0.41), or (-0.40)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-2.795	1329	relative claim charge (-0.54), length of stay (-0.47), or (-0.36)

Tier 3 (n=10 codes)

code	Description	Score	N claims	Key drivers
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	0.367	1451	work rvu (+0.78), or (-0.36), multiple or days (-0.30)
B24BZZ4	ULTRASONOGRAPHY OF HEART WITH AORTA, TRANSESOPHAGEAL	0.232	1102	n distinct rev codes (+0.33), multiple or days (-0.30), length of stay (+0.17)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-0.061	1297	n distinct rev codes (-0.26), work rvu (-0.25), n distinct hcps (+0.23)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	-0.079	2004	n distinct hcps (-0.45), or (+0.23), organ system count (+0.15)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.364	2301	n distinct rev codes (+0.32), or (-0.30), multiple or days (-0.23)
B24BYZZ	ULTRASONOGRAPHY OF HEART WITH AORTA USING OTHER CONTRAST	-0.582	1028	n distinct hcps (-0.38), length of stay (-0.30), n j code lines (+0.30)
5A2204Z	RESTORATION OF CARDIAC RHYTHM, SINGLE	-0.697	1613	multiple or days (-0.30), or (-0.20), n imaging lines (-0.19)
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	-1.038	1871	length of stay (-0.34), or (-0.31), n distinct rev codes (+0.27)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-1.065	16783	organ system count (+0.45), relative claim charge (-0.31), length of stay (-0.31)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	-1.214	4044	n distinct hcps (-0.38), length of stay (-0.32), or (-0.32)

Tier 4 (n=15 codes)

code	Description	Score	N claims	Key drivers
0B9J8ZX	DRAINAGE OF LEFT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.114	1885	or (+0.53), multiple or days (+0.50), n distinct rev codes (+0.40)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	1.777	1170	or (+0.58), organ system count (+0.42), n distinct rev codes (+0.28)
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	1.765	1031	multiple or days (+0.85), n distinct hcps (-0.43), length of stay (+0.34)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.729	9477	transfusion (+1.16), organ system count (+0.33), n distinct rev codes (+0.21)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.683	1099	n imaging lines (+1.09), multiple or days (+0.30), work rvu (+0.25)
5A0955A	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, HIGH NASAL FLOW/VELOCITY	1.649	1747	length of stay (+0.99), relative claim charge (+0.84), work rvu (+0.25)
0B9C8ZX	DRAINAGE OF RIGHT UPPER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.609	1869	or (+0.50), multiple or days (+0.35), n distinct rev codes (+0.35)
0W993ZX	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.499	1453	or (+0.45), n distinct rev codes (+0.40), n imaging lines (+0.32)
5A09557	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.478	1680	relative claim charge (+1.12), length of stay (+0.97), multiple or days (-0.30)
0W9B3ZX	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.272	1035	or (+0.44), n distinct rev codes (+0.42), n distinct hcps (+0.29)

Tier 5 (n=7 codes)

code	Description	Score	N claims	Key drivers
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	3.913	4937	length of stay (+0.68), relative claim charge (+0.66), n distinct rev codes (+0.50)
0W9930Z	DRAINAGE OF RIGHT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	3.400	2240	length of stay (+0.64), relative claim charge (+0.61), or (+0.53)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.989	1626	n distinct rev codes (+0.61), organ system count (+0.55), length of stay (+0.43)
0W9B30Z	DRAINAGE OF LEFT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	2.633	1778	length of stay (+0.57), relative claim charge (+0.56), or (+0.50)
0B9G8ZX	DRAINAGE OF LEFT UPPER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.578	1252	multiple or days (+0.85), or (+0.54), n distinct hcps (+0.39)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.465	1851	n distinct rev codes (+0.70), organ system count (+0.50), n imaging lines (+0.40)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.353	1892	or (+0.52), multiple or days (+0.47), n distinct rev codes (+0.41)

Key Driver Frequency

feature	count	pct
n distinct rev codes	27	58.700
or	24	52.200
length of stay	23	50.000
relative claim charge	14	30.400
n imaging lines	12	26.100
multiple or days	12	26.100
n distinct hcps	9	19.600
organ system count	8	17.400
work rvu	6	13.000
transfusion	1	2.200
n j code lines	1	2.200
icu	1	2.200