IP - PU.1.ventilator_over_96

CM Codes

Data Overview

8306 total codes in komodo_rii; 159 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	69
CC	48
MCC	42

PCA Analysis

PC1 explains 30.0% of variance; PC1+PC2 together explain 48.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	n imaging lines	organ system count	n j code lines	icu	or	relative claim charge
1	18.000	20868.000	18.505	22.923	0.727	5.917	0.584	0.653	0.299	0.962
2	54.000	131997.000	20.720	21.377	1.014	6.430	0.758	0.734	0.369	0.999
3	55.000	140461.000	22.351	19.646	1.213	6.097	0.867	0.798	0.426	1.046
4	32.000	51785.000	23.649	19.198	1.493	6.191	1.014	0.850	0.464	1.095

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	6	17	18	7	48
MCC	6	8	16	12	42
No CC/MCC	6	29	21	13	69
All	18	54	55	32	159

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.483	0.054	0.081
rate_or	0.476	0.027	0.141
avg_n_imaging_lines	0.406	0.181	0.096
rate_icu	0.397	0.030	0.071
avg_relative_claim_charge	0.250	0.027	0.296
rate_transfusion	0.207	-0.004	0.282
avg_n_j_code_lines	0.174	0.080	0.088
rate_dialysis	0.116	0.062	0.280
rate_multiple_or_days	0.104	0.154	0.203
avg_n_distinct_hcps	0.086	-0.162	-0.635
avg_work_rvu	0.041	0.029	-0.040
rate_mechanical_ventilation	-0.000	nan	nan
avg_organ_system_count	-0.027	-0.090	-0.691
avg_length_of_stay	-0.222	-0.000	0.090

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	3.108	4	683	or (+0.79), n distinct rev codes (+0.73), n imaging lines (+0.45)
I2489	Other forms of acute ischemic heart disease	No CC/MCC	2.662	4	541	n distinct rev codes (+0.66), icu (+0.63), or (+0.62)
E8770	Fluid overload, unspecified	No CC/MCC	2.541	4	756	icu (+0.62), n j code lines (+0.55), n distinct rev codes (+0.47)
E11649	Type 2 diabetes mellitus with hypoglycemia without coma	No CC/MCC	2.210	4	668	n distinct rev codes (+0.67), or (+0.48), n imaging lines (+0.46)
E8720	Acidosis, unspecified	No CC/MCC	2.160	4	4308	n imaging lines (+0.58), icu (+0.51), n distinct rev codes (+0.45)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J9620	Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-5.060	1	1315	or (-1.30), n distinct rev codes (-1.28), n imaging lines (-0.90)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	-3.754	1	2194	or (-1.14), n distinct rev codes (-0.74), icu (-0.69)
J9690	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	MCC	-3.680	1	1635	or (-1.24), n distinct rev codes (-0.74), n imaging lines (-0.65)
G800	Spastic quadriplegic cerebral palsy	MCC	-3.650	1	635	n distinct rev codes (-1.38), n imaging lines (-0.99), or (-0.77)
G8250	Quadriplegia, unspecified	MCC	-3.378	1	1084	n distinct rev codes (-1.13), or (-0.84), n imaging lines (-0.41)

Top Codes by Tier

Tier 1 (n=18 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-2.633	2379	or (-0.62), n distinct rev codes (-0.50), icu (-0.40)
I5030	Unspecified diastolic (congestive) heart failure	CC	-2.816	649	icu (-0.82), or (-0.63), n distinct rev codes (-0.61)
L89153	Pressure ulcer of sacral region, stage 3	MCC	-2.910	1176	icu (-0.67), n distinct rev codes (-0.67), length of stay (-0.57)
G7281	Critical illness myopathy	CC	-2.929	2156	icu (-0.80), length of stay (-0.67), or (-0.62)
B9689	Other specified bacterial agents as the cause of diseases classified elsewhere	No CC/MCC	-3.037	614	n distinct rev codes (-0.85), n imaging lines (-0.67), or (-0.63)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	-3.060	2091	icu (-0.78), or (-0.63), n distinct rev codes (-0.52)
I69351	Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side	CC	-3.130	587	icu (-0.79), n distinct rev codes (-0.66), or (-0.55)
I69354	Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side	CC	-3.303	683	or (-0.79), icu (-0.74), n distinct rev codes (-0.59)
G8250	Quadriplegia, unspecified	MCC	-3.378	1084	n distinct rev codes (-1.13), or (-0.84), n imaging lines (-0.41)
J9611	Chronic respiratory failure with hypoxia	CC	-3.384	854	n distinct rev codes (-0.98), icu (-0.76), or (-0.62)

Tier 2 (n=54 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I110	Hypertensive heart disease with heart failure	No CC/MCC	-0.275	3991	transfusion (-0.24), relative claim charge (-0.12), icu (+0.11)
E441	Mild protein-calorie malnutrition	CC	-0.292	516	n imaging lines (-0.19), n distinct rev codes (+0.15), length of stay (+0.13)
K567	Ileus, unspecified	CC	-0.305	1395	relative claim charge (+0.48), length of stay (-0.40), icu (-0.14)
F319	Bipolar disorder, unspecified	No CC/MCC	-0.346	662	relative claim charge (-0.34), transfusion (-0.23), or (-0.23)
G8929	Other chronic pain	No CC/MCC	-0.375	774	relative claim charge (-0.36), transfusion (-0.29), length of stay (+0.21)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	-0.392	951	multiple or days (-0.15), n j code lines (-0.14), n distinct hcps (+0.13)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	-0.407	7955	transfusion (-0.21), n imaging lines (-0.16), icu (+0.16)
J156	None	MCC	-0.411	752	n imaging lines (-0.23), length of stay (-0.21), multiple or days (-0.19)
N189	Chronic kidney disease, unspecified	No CC/MCC	-0.419	1032	or (-0.28), relative claim charge (-0.20), transfusion (+0.11)
E039	Hypothyroidism, unspecified	No CC/MCC	-0.500	2603	icu (-0.19), or (-0.13), n distinct rev codes (-0.13)

Tier 3 (n=55 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I4710	Supraventricular tachycardia, unspecified	No CC/MCC	1.693	577	relative claim charge (+0.74), or (+0.48), n distinct rev codes (+0.37)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	1.644	1204	n imaging lines (+0.58), n distinct rev codes (+0.40), icu (+0.33)
Q2112	Patent foramen ovale	No CC/MCC	1.600	509	relative claim charge (+1.60), icu (-1.02), n imaging lines (-0.70)
I5043	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure	MCC	1.575	1419	or (+0.58), n distinct rev codes (+0.51), n imaging lines (+0.28)
D62	Acute posthemorrhagic anemia	CC	1.563	2182	transfusion (+0.82), or (+0.41), n distinct rev codes (+0.40)
J1282	Pneumonia due to coronavirus disease 2019	No CC/MCC	1.512	1687	icu (+0.48), n distinct rev codes (+0.32), or (+0.31)
T380X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter	No CC/MCC	1.505	560	icu (+0.69), or (+0.44), n distinct rev codes (+0.35)
N186	End stage renal disease	MCC	1.497	3019	dialysis (+0.70), transfusion (+0.44), or (+0.24)
U071	COVID-19	MCC	1.377	2389	icu (+0.40), n distinct rev codes (+0.30), or (+0.24)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	1.376	1822	or (+0.48), n distinct rev codes (+0.34), icu (+0.22)

Tier 4 (n=32 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J80	Acute respiratory distress syndrome	MCC	4.383	3344	or (+1.33), n distinct rev codes (+0.77), icu (+0.70)
I468	Cardiac arrest due to other underlying condition	MCC	4.347	767	n imaging lines (+1.28), n distinct rev codes (+0.93), icu (+0.75)
K7200	Acute and subacute hepatic failure without coma	MCC	3.959	1371	n imaging lines (+1.09), n distinct rev codes (+0.88), or (+0.55)
D61818	Other pancytopenia	CC	3.391	584	transfusion (+0.82), n distinct rev codes (+0.75), or (+0.59)
J811	Chronic pulmonary edema	CC	3.277	681	n j code lines (+0.98), or (+0.54), relative claim charge (+0.40)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	3.108	683	or (+0.79), n distinct rev codes (+0.73), n imaging lines (+0.45)
I161	Hypertensive emergency	CC	3.020	619	n imaging lines (+0.92), n distinct rev codes (+0.87), icu (+0.67)
J810	Acute pulmonary edema	MCC	2.993	729	n distinct rev codes (+0.61), icu (+0.45), or (+0.44)
A419	Sepsis, unspecified organism	MCC	2.855	6615	or (+0.73), n distinct rev codes (+0.48), n imaging lines (+0.38)
E874	Mixed disorder of acid-base balance	CC	2.839	2428	n distinct rev codes (+0.64), icu (+0.63), or (+0.56)

Key Driver Frequency

feature	count	pct
or	109	68.600
n distinct rev codes	108	67.900
icu	91	57.200
n imaging lines	52	32.700
relative claim charge	31	19.500
transfusion	30	18.900
length of stay	28	17.600
n j code lines	14	8.800
multiple or days	5	3.100
dialysis	5	3.100
n distinct hcps	4	2.500

PCS Codes

Data Overview

1935 total codes in komodo_rii; 54 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 34.2% of variance; PC1+PC2 together explain 55.5%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	n j code lines	work rvu	n imaging lines	organ system count	icu	or
1	1.000	1255.000	30.441	15.583	0.060	0.251	0.299	4.420	0.351	0.149
2	9.000	53726.000	24.229	21.178	0.738	0.620	0.956	5.354	0.689	0.425
3	25.000	63075.000	19.908	23.964	1.040	1.015	1.411	5.536	0.847	0.534
4	19.000	25995.000	20.570	25.555	1.758	1.758	1.661	5.748	0.889	0.589

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.438	-0.150
avg_n_imaging_lines	0.416	0.009
rate_icu	0.402	0.191
rate_or	0.350	-0.233
avg_organ_system_count	0.324	-0.040
avg_work_rvu	0.319	0.260
avg_n_j_code_lines	0.273	0.252
rate_dialysis	0.139	0.105
rate_transfusion	0.082	-0.284
avg_relative_claim_charge	0.077	-0.450
rate_multiple_or_days	0.001	0.008
rate_mechanical_ventilation	-0.000	nan
avg_n_distinct_hcps	-0.011	-0.005
avg_length_of_stay	-0.193	-0.249

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=1 codes)

code	Description	Score	N claims	Key drivers
4A12X4Z	MONITORING OF CARDIAC ELECTRICAL ACTIVITY, EXTERNAL APPROACH	-8.905	1255	icu (-1.76), n distinct rev codes (-1.72), n imaging lines (-1.39)

Tier 2 (n=9 codes)

code	Description	Score	N claims	Key drivers
8E0ZXY6	ISOLATION	-1.984	581	n distinct rev codes (-0.71), or (-0.41), work rvu (-0.33)
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	-2.335	43003	n distinct rev codes (-0.60), or (-0.45), n imaging lines (-0.38)
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	-2.399	591	n distinct rev codes (-0.51), work rvu (-0.50), n imaging lines (-0.45)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	-2.530	755	n distinct rev codes (-0.55), n imaging lines (-0.50), work rvu (-0.47)
30243N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	-2.710	846	icu (-0.73), n imaging lines (-0.65), n distinct rev codes (-0.50)
3E0436Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	-2.716	506	icu (-0.94), organ system count (-0.92), n imaging lines (-0.64)
0B21XFZ	CHANGE TRACHEOSTOMY DEVICE IN TRACHEA, EXTERNAL APPROACH	-3.099	1930	n distinct rev codes (-0.83), n imaging lines (-0.75), length of stay (-0.39)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	-3.386	4885	n distinct rev codes (-0.80), n imaging lines (-0.59), or (-0.56)
5A09557	ASSISTANCE WITH RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-4.503	629	icu (-1.09), n imaging lines (-0.80), organ system count (-0.58)

Tier 3 (n=25 codes)

code	Description	Score	N claims	Key drivers
04HY32Z	INSERTION OF MONITORING DEVICE INTO LOWER ARTERY, PERCUTANEOUS APPROACH	0.866	888	n imaging lines (+0.40), length of stay (+0.24), n distinct rev codes (+0.23)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	0.843	881	or (+0.31), n distinct rev codes (+0.30), n j code lines (-0.17)
0BH18EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.829	1305	work rvu (+0.26), icu (+0.22), n j code lines (+0.19)
0BJ08ZZ	INSPECTION OF TRACHEOBRONCHIAL TREE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.554	2209	or (+0.44), n j code lines (+0.22), work rvu (+0.20)
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	0.550	1011	organ system count (-0.33), n imaging lines (+0.25), length of stay (+0.19)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	0.497	10326	icu (+0.16), or (+0.15), length of stay (+0.11)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	0.468	651	or (+0.51), icu (-0.29), n distinct rev codes (+0.22)
5A12012	PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL	0.352	1761	n imaging lines (+0.41), or (-0.21), length of stay (+0.16)
05HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	0.278	879	n j code lines (-0.25), icu (+0.22), n imaging lines (+0.17)
0W9B30Z	DRAINAGE OF LEFT PLEURAL CAVITY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	0.244	875	n j code lines (-0.27), n imaging lines (+0.27), or (+0.23)

Tier 4 (n=19 codes)

code	Description	Score	N claims	Key drivers
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	3.544	719	n distinct rev codes (+0.84), organ system count (+0.60), n imaging lines (+0.56)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	3.021	635	n distinct rev codes (+0.98), or (+0.96), organ system count (+0.82)
0B9C8ZX	DRAINAGE OF RIGHT UPPER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.577	659	n j code lines (+0.77), work rvu (+0.44), or (+0.44)
0B9F8ZX	DRAINAGE OF RIGHT LOWER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.226	1614	n j code lines (+0.66), work rvu (+0.57), or (+0.46)
0B9D8ZX	DRAINAGE OF RIGHT MIDDLE LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	2.193	1507	work rvu (+0.77), n distinct rev codes (+0.44), or (+0.34)
4A133J1	MONITORING OF ARTERIAL PULSE, PERIPHERAL, PERCUTANEOUS APPROACH	2.158	1227	work rvu (+0.48), n j code lines (+0.46), icu (+0.41)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	2.114	944	n imaging lines (+1.14), n distinct rev codes (+0.60), icu (+0.19)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.069	684	n distinct rev codes (+0.68), organ system count (+0.57), or (+0.45)
0B9G8ZX	DRAINAGE OF LEFT UPPER LUNG LOBE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.897	504	n j code lines (+0.63), or (+0.37), n distinct rev codes (+0.35)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	1.806	1626	icu (+0.39), work rvu (+0.38), n j code lines (+0.36)

Key Driver Frequency

feature	count	pct
or	26	48.100
n imaging lines	24	44.400
n j code lines	22	40.700
icu	22	40.700
work rvu	21	38.900
n distinct rev codes	21	38.900
organ system count	16	29.600
length of stay	8	14.800
dialysis	1	1.900
transfusion	1	1.900