IP - UR.1.UTI

CM Codes

Data Overview

14174 total codes in komodo_rii; 467 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	325
CC	114
MCC	28

PCA Analysis

PC1 explains 29.0% of variance; PC1+PC2 together explain 47.8%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	n imaging lines	work rvu	icu	n j code lines	organ system count
1	293.000	2597619.000	14.659	5.247	1.037	1.048	0.401	0.134	0.386	6.111
2	166.000	560623.000	16.041	6.491	1.233	1.210	0.482	0.182	0.390	6.198
3	8.000	18912.000	18.544	8.524	1.788	1.399	0.712	0.343	0.478	6.170

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	52	61	1	114
MCC	3	18	7	28
No CC/MCC	238	87	0	325
All	293	166	8	467

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.457	-0.141	0.445
avg_n_distinct_rev_codes	0.442	-0.070	0.237
rate_icu	0.399	0.059	0.306
avg_length_of_stay	0.390	-0.128	0.282
rate_mechanical_ventilation	0.326	0.118	0.417
avg_n_imaging_lines	0.277	-0.102	0.040
avg_work_rvu	0.187	-0.079	0.147
rate_transfusion	0.157	0.003	0.383
rate_multiple_or_days	0.151	0.144	0.215
avg_organ_system_count	0.090	-0.116	-0.363
rate_dialysis	0.086	0.085	0.341
avg_n_j_code_lines	0.023	-0.044	0.115
rate_or	-0.016	-0.036	0.188
avg_n_distinct_hcps	-0.047	-0.096	-0.218

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (0 codes)

None.

Under-tiered: Tier 1, MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
N151	Renal and perinephric abscess	MCC	-1.138	1	3544	n distinct rev codes (-0.46), icu (-0.31), relative claim charge (+0.27)
K8590	Acute pancreatitis without necrosis or infection, unspecified	MCC	-0.934	1	820	length of stay (-0.44), n distinct rev codes (-0.43), relative claim charge (-0.24)
U071	COVID-19	MCC	0.167	1	6824	length of stay (+0.43), relative claim charge (+0.27), n imaging lines (-0.17)

Top Codes by Tier

Tier 1 (n=293 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I7140	Abdominal aortic aneurysm, without rupture, unspecified	No CC/MCC	0.181	1373	multiple or days (+0.35), relative claim charge (-0.34), work rvu (+0.32)
M1711	Unilateral primary osteoarthritis, right knee	No CC/MCC	0.176	901	work rvu (+0.37), length of stay (+0.31), icu (-0.31)
I4510	Unspecified right bundle-branch block	No CC/MCC	0.173	2435	icu (+0.32), n distinct rev codes (+0.25), work rvu (-0.15)
I428	Other cardiomyopathies	CC	0.173	2463	icu (+0.27), n imaging lines (-0.08), organ system count (-0.08)
U071	COVID-19	MCC	0.167	6824	length of stay (+0.43), relative claim charge (+0.27), n imaging lines (-0.17)
K838	Other specified diseases of biliary tract	No CC/MCC	0.165	1022	n imaging lines (+0.58), icu (-0.19), n distinct rev codes (+0.15)
I160	Hypertensive urgency	No CC/MCC	0.142	6434	icu (+0.49), n imaging lines (+0.24), length of stay (-0.20)
I4819	Other persistent atrial fibrillation	CC	0.138	3510	icu (+0.27), n distinct rev codes (+0.18), multiple or days (-0.13)
F0394	Unspecified dementia, unspecified severity, with anxiety	No CC/MCC	0.138	4052	length of stay (+0.27), n imaging lines (+0.18), icu (-0.13)
G3183	Neurocognitive disorder with Lewy bodies	No CC/MCC	0.135	1042	length of stay (+0.36), relative claim charge (-0.24), n imaging lines (+0.23)

Tier 2 (n=166 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5033	Acute on chronic diastolic (congestive) heart failure	MCC	4.520	3744	relative claim charge (+1.11), n distinct rev codes (+1.04), length of stay (+0.83)
N170	Acute kidney failure with tubular necrosis	MCC	4.392	3831	relative claim charge (+1.28), n distinct rev codes (+0.70), length of stay (+0.65)
I5023	Acute on chronic systolic (congestive) heart failure	MCC	4.353	1428	relative claim charge (+1.21), icu (+0.97), n distinct rev codes (+0.89)
M6281	Muscle weakness (generalized)	No CC/MCC	4.260	3416	length of stay (+3.10), n distinct rev codes (+1.47), relative claim charge (-0.48)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	4.182	1175	relative claim charge (+0.93), n distinct rev codes (+0.76), length of stay (+0.64)
E7220	Disorder of urea cycle metabolism, unspecified	CC	3.945	847	relative claim charge (+1.35), mechanical ventilation (+0.63), n distinct rev codes (+0.60)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	3.915	1509	icu (+1.25), relative claim charge (+1.13), n distinct rev codes (+0.70)
J9612	Chronic respiratory failure with hypercapnia	CC	3.894	1169	mechanical ventilation (+1.71), relative claim charge (+0.86), n distinct rev codes (+0.47)
D62	Acute posthemorrhagic anemia	CC	3.780	5706	transfusion (+1.36), relative claim charge (+0.97), n distinct rev codes (+0.62)
I5031	Acute diastolic (congestive) heart failure	MCC	3.725	745	n distinct rev codes (+1.14), icu (+1.04), relative claim charge (+1.01)

Tier 3 (n=8 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	14.572	705	mechanical ventilation (+4.40), relative claim charge (+3.08), icu (+2.93)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	11.620	1027	relative claim charge (+2.85), icu (+2.56), mechanical ventilation (+2.27)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.731	3067	relative claim charge (+2.51), mechanical ventilation (+1.70), n distinct rev codes (+1.52)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	8.500	2658	relative claim charge (+2.09), icu (+1.73), mechanical ventilation (+1.70)
J9601	Acute respiratory failure with hypoxia	MCC	7.402	8307	relative claim charge (+1.67), mechanical ventilation (+1.46), n distinct rev codes (+1.30)
I639	Cerebral infarction, unspecified	MCC	6.707	1311	n imaging lines (+1.51), n distinct rev codes (+1.47), icu (+1.13)
I5043	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure	MCC	5.772	923	relative claim charge (+1.49), n distinct rev codes (+1.18), icu (+1.00)
K922	Gastrointestinal hemorrhage, unspecified	CC	5.495	914	transfusion (+0.90), relative claim charge (+0.80), n distinct rev codes (+0.79)

Key Driver Frequency

feature	count	pct
n distinct rev codes	303	64.900
relative claim charge	287	61.500
length of stay	239	51.200
icu	223	47.800
n imaging lines	119	25.500
work rvu	75	16.100
multiple or days	56	12.000
mechanical ventilation	37	7.900
transfusion	34	7.300
organ system count	23	4.900
dialysis	5	1.100

PCS Codes

Data Overview

2581 total codes in komodo_rii; 41 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 37.5% of variance; PC1+PC2 together explain 53.4%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	organ system count	relative claim charge	work rvu	n imaging lines	or	n distinct hcps
1	6.000	9451.000	3.890	15.571	4.722	1.245	0.195	0.941	0.634	1.158
2	19.000	28865.000	5.935	15.680	5.099	1.426	0.280	0.981	0.537	0.888
3	12.000	29738.000	7.090	18.129	5.643	1.693	0.411	1.258	0.293	0.867
4	4.000	4115.000	8.738	18.685	5.661	2.022	0.873	1.494	0.321	0.879

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_length_of_stay	0.385	-0.018
rate_icu	0.374	0.257
avg_work_rvu	0.359	-0.031
avg_organ_system_count	0.344	0.008
avg_relative_claim_charge	0.329	-0.160
avg_n_imaging_lines	0.282	0.204
rate_mechanical_ventilation	0.276	0.157
avg_n_distinct_rev_codes	0.272	-0.179
rate_transfusion	0.157	-0.091
avg_n_j_code_lines	0.140	-0.008
rate_dialysis	0.091	0.189
rate_multiple_or_days	-0.042	-0.051
rate_or	-0.190	-0.241
avg_n_distinct_hcps	-0.191	-0.322

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=6 codes)

code	Description	Score	N claims	Key drivers
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.879	4500	icu (-0.66), relative claim charge (-0.62), n distinct rev codes (-0.56)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-2.931	821	icu (-0.86), relative claim charge (-0.63), n distinct rev codes (-0.55)
BT1D1ZZ	FLUOROSCOPY OF RIGHT KIDNEY, URETER AND BLADDER USING LOW OSMOLAR CONTRAST	-3.168	1335	n distinct hcps (-0.64), length of stay (-0.62), organ system count (-0.39)
0TC68ZZ	EXTIRPATION OF MATTER FROM RIGHT URETER, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-3.297	692	length of stay (-0.80), organ system count (-0.76), icu (-0.35)
BT1F1ZZ	FLUOROSCOPY OF LEFT KIDNEY, URETER AND BLADDER USING LOW OSMOLAR CONTRAST	-3.313	1340	n distinct hcps (-0.68), length of stay (-0.64), icu (-0.44)
0TC78ZZ	EXTIRPATION OF MATTER FROM LEFT URETER, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-3.644	763	length of stay (-0.77), organ system count (-0.76), icu (-0.50)

Tier 2 (n=19 codes)

code	Description	Score	N claims	Key drivers
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	0.055	937	length of stay (+0.39), n distinct rev codes (-0.29), icu (-0.28)
05H933Z	INSERTION OF INFUSION DEVICE INTO RIGHT BRACHIAL VEIN, PERCUTANEOUS APPROACH	-0.159	844	work rvu (-0.28), n distinct hcps (+0.25), organ system count (+0.15)
05HA33Z	INSERTION OF INFUSION DEVICE INTO LEFT BRACHIAL VEIN, PERCUTANEOUS APPROACH	-0.167	771	relative claim charge (-0.26), n distinct hcps (+0.26), n distinct rev codes (-0.10)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	-0.252	1845	organ system count (-0.67), n imaging lines (+0.25), mechanical ventilation (+0.17)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	-0.495	2726	relative claim charge (-0.24), n distinct hcps (+0.22), n j code lines (-0.14)
05HB33Z	INSERTION OF INFUSION DEVICE INTO RIGHT BASILIC VEIN, PERCUTANEOUS APPROACH	-0.883	2027	work rvu (-0.40), relative claim charge (-0.29), n distinct hcps (+0.16)
0T9130Z	DRAINAGE OF LEFT KIDNEY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-0.889	1238	organ system count (-0.37), or (-0.20), n imaging lines (-0.13)
0T9430Z	DRAINAGE OF LEFT KIDNEY PELVIS WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-1.016	1495	organ system count (-0.38), or (-0.21), length of stay (-0.15)
0T25X0Z	CHANGE DRAINAGE DEVICE IN KIDNEY, EXTERNAL APPROACH	-1.036	1362	icu (-0.25), n imaging lines (-0.21), or (-0.21)
0T9330Z	DRAINAGE OF RIGHT KIDNEY PELVIS WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-1.144	1544	organ system count (-0.39), or (-0.21), length of stay (-0.19)

Tier 3 (n=12 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.767	5474	transfusion (+0.87), icu (+0.41), length of stay (+0.35)
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.562	1325	organ system count (+0.48), length of stay (+0.44), relative claim charge (+0.42)
4A03X5D	MEASUREMENT OF ARTERIAL FLOW, INTRACRANIAL, EXTERNAL APPROACH	2.217	1369	n imaging lines (+1.07), icu (+0.69), organ system count (+0.33)
0DJD8ZZ	INSPECTION OF LOWER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.132	770	length of stay (+0.48), relative claim charge (+0.47), organ system count (+0.46)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.948	877	organ system count (+0.51), n distinct rev codes (+0.46), length of stay (+0.25)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.894	1771	n distinct rev codes (+0.48), organ system count (+0.36), length of stay (+0.34)
B24BZZZ	ULTRASONOGRAPHY OF HEART WITH AORTA	1.613	1553	icu (+0.64), work rvu (+0.39), n imaging lines (+0.26)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	1.520	3054	icu (+0.62), organ system count (+0.47), or (+0.19)
0DB98ZX	EXCISION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.318	779	n distinct rev codes (+0.43), organ system count (+0.34), relative claim charge (+0.24)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	1.236	6600	mechanical ventilation (+0.35), icu (+0.28), length of stay (+0.24)

Tier 4 (n=4 codes)

code	Description	Score	N claims	Key drivers
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	5.905	908	mechanical ventilation (+1.49), length of stay (+1.11), work rvu (+1.06)
4A00X4Z	MEASUREMENT OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	4.942	884	work rvu (+1.39), n imaging lines (+0.78), n j code lines (+0.63)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	3.889	1584	n imaging lines (+0.76), icu (+0.56), work rvu (+0.52)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	3.293	739	length of stay (+0.88), relative claim charge (+0.88), work rvu (+0.49)

Key Driver Frequency

feature	count	pct
icu	20	48.800
organ system count	18	43.900
length of stay	17	41.500
relative claim charge	14	34.100
n distinct rev codes	11	26.800
work rvu	10	24.400
n imaging lines	9	22.000
or	8	19.500
n distinct hcps	8	19.500
mechanical ventilation	4	9.800
n j code lines	2	4.900
dialysis	1	2.400
transfusion	1	2.400