IP - UR.1.other_diag

CM Codes

Data Overview

12967 total codes in komodo_rii; 527 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	303
CC	167
MCC	57

PCA Analysis

PC1 explains 37.0% of variance; PC1+PC2 together explain 53.0%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	n imaging lines	relative claim charge	work rvu	icu	n j code lines
1	9.000	21061.000	10.390	2.213	2.009	0.193	0.726	0.316	0.065	0.457
2	255.000	1550544.000	14.874	5.991	6.698	0.842	0.977	0.497	0.223	0.485
3	197.000	758416.000	16.304	7.180	6.920	0.968	1.181	0.603	0.295	0.555
4	66.000	182464.000	18.436	9.102	6.921	1.156	1.591	0.752	0.440	0.696

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	6	70	66	25	167
MCC	0	0	27	30	57
No CC/MCC	3	185	104	11	303
All	9	255	197	66	527

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.411	-0.024	0.339
avg_relative_claim_charge	0.394	-0.070	0.444
rate_icu	0.386	0.065	0.388
avg_length_of_stay	0.380	-0.063	0.327
avg_n_imaging_lines	0.311	-0.062	0.327
rate_mechanical_ventilation	0.299	0.040	0.464
rate_transfusion	0.242	0.005	0.377
avg_organ_system_count	0.195	-0.030	-0.319
avg_n_j_code_lines	0.187	-0.078	0.192
avg_work_rvu	0.187	-0.061	0.074
rate_multiple_or_days	0.123	0.008	0.122
avg_n_distinct_hcps	0.094	-0.136	-0.237
rate_dialysis	0.064	0.031	0.050
rate_or	0.047	-0.058	0.192

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
J1282	Pneumonia due to coronavirus disease 2019	No CC/MCC	4.061	4	681	relative claim charge (+1.29), length of stay (+0.86), n distinct rev codes (+0.75)
G928	Other toxic encephalopathy	No CC/MCC	4.038	4	10615	n imaging lines (+0.86), n distinct rev codes (+0.74), relative claim charge (+0.64)
E8729	Other acidosis	No CC/MCC	3.732	4	1891	icu (+0.95), relative claim charge (+0.73), n distinct rev codes (+0.62)
G9389	Other specified disorders of brain	No CC/MCC	3.609	4	674	n imaging lines (+1.26), n distinct rev codes (+0.67), icu (+0.50)
M6281	Muscle weakness (generalized)	No CC/MCC	3.381	4	1250	length of stay (+2.62), n distinct rev codes (+1.12), relative claim charge (-0.46)

Under-tiered: Tier 1, MCC (0 codes)

None.

Top Codes by Tier

Tier 1 (n=9 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N049	Nephrotic syndrome with unspecified morphologic changes	CC	-4.398	3353	n distinct rev codes (-0.83), n imaging lines (-0.82), organ system count (-0.55)
N1370	Vesicoureteral-reflux, unspecified	No CC/MCC	-4.593	552	n distinct rev codes (-1.02), n imaging lines (-0.81), length of stay (-0.79)
N040	Nephrotic syndrome with minor glomerular abnormality	CC	-5.177	801	n distinct rev codes (-1.16), n imaging lines (-0.94), icu (-0.67)
Q600	Renal agenesis, unilateral	CC	-6.392	1496	n distinct rev codes (-1.21), length of stay (-1.15), organ system count (-0.90)
Q614	Renal dysplasia	CC	-7.658	967	n distinct rev codes (-1.46), length of stay (-1.45), n imaging lines (-1.27)
Q6239	Other obstructive defects of renal pelvis and ureter	CC	-7.770	614	length of stay (-1.43), n distinct rev codes (-1.39), n imaging lines (-1.19)
Q638	Other specified congenital malformations of kidney	No CC/MCC	-8.741	829	n distinct rev codes (-1.85), length of stay (-1.51), organ system count (-1.28)
Q632	Ectopic kidney	No CC/MCC	-9.459	616	n distinct rev codes (-1.83), length of stay (-1.64), organ system count (-1.30)
Q620	Congenital hydronephrosis	CC	-9.728	11833	n distinct rev codes (-1.91), length of stay (-1.68), organ system count (-1.37)

Tier 2 (n=255 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I69351	Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side	CC	-0.340	3950	n imaging lines (+0.23), length of stay (+0.17), relative claim charge (-0.15)
K592	Neurogenic bowel, not elsewhere classified	CC	-0.342	2725	n distinct rev codes (-0.34), icu (-0.27), transfusion (-0.25)
N2581	Secondary hyperparathyroidism of renal origin	CC	-0.373	7351	n imaging lines (-0.44), multiple or days (+0.25), n distinct rev codes (-0.24)
J849	Interstitial pulmonary disease, unspecified	CC	-0.392	627	n j code lines (-0.19), work rvu (-0.18), mechanical ventilation (-0.15)
K529	Noninfective gastroenteritis and colitis, unspecified	No CC/MCC	-0.395	2700	mechanical ventilation (-0.14), length of stay (-0.13), n distinct rev codes (-0.13)
I890	Lymphedema, not elsewhere classified	No CC/MCC	-0.430	939	n imaging lines (-0.23), icu (-0.22), organ system count (+0.18)
I495	Sick sinus syndrome	No CC/MCC	-0.432	2056	n j code lines (-0.16), relative claim charge (-0.13), n distinct rev codes (+0.12)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	-0.433	6478	work rvu (-0.13), mechanical ventilation (-0.11), n imaging lines (-0.08)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	-0.447	3933	work rvu (+0.66), length of stay (-0.28), relative claim charge (-0.26)
M419	Scoliosis, unspecified	No CC/MCC	-0.461	592	n distinct rev codes (-0.28), transfusion (-0.27), organ system count (+0.24)

Tier 3 (n=197 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E43	Unspecified severe protein-calorie malnutrition	MCC	2.404	18894	length of stay (+0.57), relative claim charge (+0.49), n distinct rev codes (+0.47)
F05	Delirium due to known physiological condition	CC	2.398	4485	length of stay (+0.82), n imaging lines (+0.48), relative claim charge (+0.36)
G9349	Other encephalopathy	CC	2.329	1944	n imaging lines (+0.54), n distinct rev codes (+0.43), icu (+0.34)
M4628	Osteomyelitis of vertebra, sacral and sacrococcygeal region	CC	2.313	2005	length of stay (+0.45), n imaging lines (+0.36), organ system count (+0.31)
A4189	Other specified sepsis	MCC	2.311	2527	icu (+0.58), n distinct rev codes (+0.37), relative claim charge (+0.37)
I161	Hypertensive emergency	CC	2.246	1474	icu (+0.99), n distinct rev codes (+0.35), relative claim charge (+0.33)
I248	None	CC	2.245	1297	icu (+0.65), n distinct rev codes (+0.52), length of stay (+0.26)
E162	Hypoglycemia, unspecified	No CC/MCC	2.185	1119	icu (+0.58), n distinct rev codes (+0.32), relative claim charge (+0.24)
A0472	Enterocolitis due to Clostridium difficile, not specified as recurrent	CC	2.153	3234	length of stay (+0.63), relative claim charge (+0.49), n distinct rev codes (+0.33)
I4710	Supraventricular tachycardia, unspecified	No CC/MCC	2.134	1256	icu (+0.62), relative claim charge (+0.46), n distinct rev codes (+0.43)

Tier 4 (n=66 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	11.498	1417	mechanical ventilation (+2.57), icu (+1.90), relative claim charge (+1.87)
K7200	Acute and subacute hepatic failure without coma	MCC	9.791	825	mechanical ventilation (+1.95), relative claim charge (+1.91), icu (+1.84)
J9622	Acute and chronic respiratory failure with hypercapnia	MCC	8.640	2090	mechanical ventilation (+1.83), icu (+1.80), relative claim charge (+1.77)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	8.277	589	mechanical ventilation (+2.22), icu (+1.25), relative claim charge (+1.16)
E874	Mixed disorder of acid-base balance	CC	7.286	1351	relative claim charge (+1.41), icu (+1.11), n distinct rev codes (+1.00)
J690	Pneumonitis due to inhalation of food and vomit	MCC	7.218	6061	relative claim charge (+1.40), length of stay (+1.08), n distinct rev codes (+1.08)
J9621	Acute and chronic respiratory failure with hypoxia	MCC	6.947	5822	relative claim charge (+1.44), mechanical ventilation (+1.42), icu (+1.42)
G931	Anoxic brain damage, not elsewhere classified	CC	6.587	948	mechanical ventilation (+2.72), icu (+1.23), relative claim charge (+0.97)
I639	Cerebral infarction, unspecified	MCC	6.524	653	n imaging lines (+1.82), n distinct rev codes (+1.18), length of stay (+0.96)
I5021	Acute systolic (congestive) heart failure	MCC	6.186	535	n distinct rev codes (+1.23), icu (+1.06), relative claim charge (+1.01)

Key Driver Frequency

feature	count	pct
relative claim charge	274	52.000
n distinct rev codes	268	50.900
icu	227	43.100
length of stay	216	41.000
n imaging lines	128	24.300
transfusion	120	22.800
n j code lines	88	16.700
work rvu	81	15.400
organ system count	77	14.600
mechanical ventilation	44	8.300
multiple or days	34	6.500
n distinct hcps	16	3.000
dialysis	7	1.300
or	1	0.200

PCS Codes

Data Overview

2989 total codes in komodo_rii; 75 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 44.9% of variance; PC1+PC2 together explain 59.3%.

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	icu
1	2.000	9177.000	8.602	0.344	0.278	0.504	0.039	0.026	0.392	0.008
2	40.000	91314.000	16.823	7.171	5.754	1.485	0.869	0.387	0.569	0.271
3	23.000	49966.000	20.295	9.765	6.205	2.108	1.157	0.810	0.848	0.456
4	10.000	14258.000	22.079	12.087	6.593	2.778	1.465	1.094	1.161	0.710

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.370	-0.205
avg_length_of_stay	0.355	-0.175
rate_icu	0.336	-0.057
avg_n_imaging_lines	0.323	-0.086
avg_relative_claim_charge	0.322	-0.165
avg_work_rvu	0.322	0.007
avg_n_j_code_lines	0.300	-0.094
avg_organ_system_count	0.274	-0.021
rate_transfusion	0.225	-0.112
rate_mechanical_ventilation	0.223	0.031
rate_multiple_or_days	0.179	-0.205
rate_dialysis	0.096	-0.042
avg_n_distinct_hcps	0.081	-0.224
rate_or	-0.001	-0.162

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=2 codes)

code	Description	Score	N claims	Key drivers
3E0234Z	INTRODUCTION OF SERUM, TOXOID AND VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-7.703	4366	organ system count (-1.41), n distinct rev codes (-1.27), length of stay (-1.13)
0VTTXZZ	RESECTION OF PREPUCE, EXTERNAL APPROACH	-7.973	4811	organ system count (-1.46), n distinct rev codes (-1.24), length of stay (-1.16)

Tier 2 (n=40 codes)

code	Description	Score	N claims	Key drivers
6A551Z3	PHERESIS OF PLASMA, MULTIPLE	-0.146	633	relative claim charge (+0.72), n imaging lines (-0.64), transfusion (+0.61)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	-0.327	11108	dialysis (+0.46), n imaging lines (-0.26), length of stay (-0.14)
BT141ZZ	FLUOROSCOPY OF KIDNEYS, URETERS AND BLADDER USING LOW OSMOLAR CONTRAST	-0.541	632	multiple or days (+0.27), icu (-0.23), relative claim charge (-0.20)
0T9430Z	DRAINAGE OF LEFT KIDNEY PELVIS WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-0.631	2188	work rvu (-0.19), icu (-0.18), multiple or days (+0.16)
0T9B30Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-0.811	1718	multiple or days (+0.25), icu (-0.23), relative claim charge (-0.21)
XW033E5	INTRODUCTION OF REMDESIVIR ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH, NEW TECHNOLOGY GROUP 5	-0.880	1169	multiple or days (-0.23), n distinct rev codes (-0.22), transfusion (-0.13)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.895	5315	length of stay (-0.18), transfusion (-0.16), multiple or days (-0.15)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.912	851	organ system count (-0.25), multiple or days (-0.21), n imaging lines (-0.20)
BT1F1ZZ	FLUOROSCOPY OF LEFT KIDNEY, URETER AND BLADDER USING LOW OSMOLAR CONTRAST	-0.943	569	work rvu (-0.30), icu (-0.29), length of stay (-0.29)
05H933Z	INSERTION OF INFUSION DEVICE INTO RIGHT BRACHIAL VEIN, PERCUTANEOUS APPROACH	-0.982	1085	work rvu (-0.33), relative claim charge (-0.16), n distinct rev codes (-0.16)

Tier 3 (n=23 codes)

code	Description	Score	N claims	Key drivers
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	2.634	1437	n j code lines (+0.65), n distinct rev codes (+0.41), transfusion (+0.38)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	2.241	1834	work rvu (+0.53), n j code lines (+0.43), relative claim charge (+0.29)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.141	3101	icu (+0.80), work rvu (+0.54), n imaging lines (+0.24)
0W9B3ZZ	DRAINAGE OF LEFT PLEURAL CAVITY, PERCUTANEOUS APPROACH	2.100	745	n distinct rev codes (+0.60), length of stay (+0.50), n imaging lines (+0.34)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	1.966	1011	mechanical ventilation (+0.92), icu (+0.45), work rvu (+0.42)
0W993ZZ	DRAINAGE OF RIGHT PLEURAL CAVITY, PERCUTANEOUS APPROACH	1.679	1049	n distinct rev codes (+0.49), length of stay (+0.34), n imaging lines (+0.24)
06HY33Z	INSERTION OF INFUSION DEVICE INTO LOWER VEIN, PERCUTANEOUS APPROACH	1.655	746	relative claim charge (+0.50), icu (+0.47), work rvu (+0.24)
05HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	1.583	772	icu (+0.44), n distinct rev codes (+0.38), length of stay (+0.33)
0DB98ZX	EXCISION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.527	777	n j code lines (+0.50), work rvu (+0.33), n distinct rev codes (+0.32)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	1.521	715	n distinct rev codes (+0.38), work rvu (+0.33), multiple or days (+0.30)

Tier 4 (n=10 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	6.047	1788	relative claim charge (+1.04), mechanical ventilation (+0.92), length of stay (+0.87)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	4.966	844	n j code lines (+1.26), n imaging lines (+1.02), work rvu (+0.62)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.653	2850	mechanical ventilation (+0.79), relative claim charge (+0.72), icu (+0.68)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	4.295	1546	icu (+0.85), work rvu (+0.72), n distinct rev codes (+0.52)
4A133B1	MONITORING OF ARTERIAL PRESSURE, PERIPHERAL, PERCUTANEOUS APPROACH	4.184	657	icu (+0.84), n distinct rev codes (+0.52), n imaging lines (+0.50)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	4.107	1824	mechanical ventilation (+0.92), icu (+0.82), n distinct rev codes (+0.47)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	3.936	1580	work rvu (+1.05), icu (+0.87), n imaging lines (+0.37)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	3.591	1716	n j code lines (+0.70), length of stay (+0.63), n distinct rev codes (+0.51)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	3.417	911	length of stay (+1.21), n distinct rev codes (+0.62), n imaging lines (+0.53)
30243N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	3.319	542	transfusion (+0.99), length of stay (+0.53), n distinct rev codes (+0.37)

Key Driver Frequency

feature	count	pct
work rvu	35	46.700
n distinct rev codes	32	42.700
relative claim charge	31	41.300
icu	29	38.700
length of stay	25	33.300
n j code lines	25	33.300
n imaging lines	15	20.000
multiple or days	12	16.000
transfusion	8	10.700
organ system count	7	9.300
mechanical ventilation	4	5.300
dialysis	2	2.700