OP - BE.0.psychoses
CM Codes
Data Overview
803 total codes in komodo_rii; 20 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 15 |
| CC | 5 |
PCA Analysis
PC1 explains 36.4% of variance; PC1+PC2 together explain 64.5%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | n distinct hcps | n distinct rev codes | work rvu | relative claim charge | organ system count | n j code lines | icu | n imaging lines |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 10.000 | 18386.000 | 0.750 | 1.073 | 0.021 | 0.976 | 1.091 | 0.000 | 0.000 | 0.000 |
| 2 | 9.000 | 12497.000 | 0.660 | 1.129 | 0.038 | 1.027 | 1.056 | 0.001 | 0.000 | 0.000 |
| 3 | 1.000 | 945.000 | 0.992 | 1.315 | 0.174 | 1.107 | 1.048 | 0.000 | 0.000 | 0.000 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 3 | 2 | 0 | 5 |
| No CC/MCC | 7 | 7 | 1 | 15 |
| All | 10 | 9 | 1 | 20 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_relative_claim_charge | 0.584 | -0.114 | -0.230 |
| avg_work_rvu | 0.575 | 0.051 | 0.150 |
| avg_n_distinct_rev_codes | 0.504 | 0.198 | -0.310 |
| avg_n_distinct_hcps | 0.231 | 0.135 | -0.110 |
| avg_length_of_stay | -0.000 | nan | nan |
| avg_n_imaging_lines | 0.000 | nan | nan |
| rate_dialysis | 0.000 | nan | nan |
| rate_icu | 0.000 | nan | nan |
| rate_mechanical_ventilation | 0.000 | nan | nan |
| rate_multiple_or_days | 0.000 | nan | nan |
| rate_or | 0.000 | nan | nan |
| rate_transfusion | 0.000 | nan | nan |
| avg_n_j_code_lines | -0.034 | 0.215 | 0.370 |
| avg_organ_system_count | -0.145 | 0.177 | -0.150 |
Top 6 Tier-Discriminating Features
Bottom 6 Tier-Discriminating Features
Score Validation
Misclassification Audit (N=10 samples)
Over-tiered: Tier 3, No CC/MCC (1 codes)
| code | code_description | cms_severity | intensity_score | tier | n_claims | key_drivers |
|---|---|---|---|---|---|---|
| F50012 | Anorexia nervosa, restricting type, severe | No CC/MCC | 5.464 | 3 | 945 | work rvu (+1.94), n distinct rev codes (+1.50), relative claim charge (+1.49) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=10 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| F909 | Attention-deficit hyperactivity disorder, unspecified type | No CC/MCC | -0.349 | 1264 | work rvu (-0.40), n distinct rev codes (-0.21), relative claim charge (+0.16) |
| F411 | Generalized anxiety disorder | No CC/MCC | -0.398 | 5788 | work rvu (-0.29), n distinct hcps (-0.16), organ system count (+0.02) |
| F332 | Major depressive disorder, recurrent severe without psychotic features | CC | -0.664 | 4942 | relative claim charge (-0.45), work rvu (-0.21), n distinct rev codes (-0.14) |
| F319 | Bipolar disorder, unspecified | No CC/MCC | -0.689 | 756 | n distinct rev codes (-0.54), n distinct hcps (+0.28), relative claim charge (-0.20) |
| F603 | Borderline personality disorder | No CC/MCC | -0.785 | 860 | relative claim charge (-0.31), work rvu (-0.29), organ system count (-0.25) |
| F329 | Major depressive disorder, single episode, unspecified | No CC/MCC | -0.965 | 1866 | n distinct rev codes (-0.71), relative claim charge (-0.56), n distinct hcps (+0.37) |
| F410 | Panic disorder [episodic paroxysmal anxiety] | No CC/MCC | -1.001 | 777 | relative claim charge (-0.49), work rvu (-0.31), n distinct rev codes (-0.24) |
| F333 | Major depressive disorder, recurrent, severe with psychotic symptoms | CC | -1.182 | 636 | relative claim charge (-0.50), work rvu (-0.29), n distinct rev codes (-0.25) |
| F5001 | None | CC | -1.327 | 866 | relative claim charge (-0.78), n distinct rev codes (-0.68), organ system count (+0.07) |
| F1020 | Alcohol dependence, uncomplicated | No CC/MCC | -1.694 | 631 | relative claim charge (-1.20), organ system count (-0.29), n distinct hcps (-0.16) |
Tier 2 (n=9 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| F32A | Depression, unspecified | No CC/MCC | 1.717 | 769 | work rvu (+1.09), relative claim charge (+0.57), n distinct rev codes (-0.14) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 0.843 | 1755 | work rvu (+0.74), organ system count (-0.31), n distinct hcps (+0.16) |
| F4010 | Social phobia, unspecified | No CC/MCC | 0.554 | 594 | n distinct rev codes (+0.97), n distinct hcps (-0.44), work rvu (-0.34) |
| F339 | Major depressive disorder, recurrent, unspecified | CC | 0.239 | 646 | relative claim charge (+0.54), n distinct rev codes (-0.32), organ system count (+0.15) |
| F429 | Obsessive-compulsive disorder, unspecified | No CC/MCC | 0.214 | 503 | relative claim charge (+0.43), work rvu (-0.37), n distinct hcps (+0.22) |
| F902 | Attention-deficit hyperactivity disorder, combined type | No CC/MCC | 0.079 | 642 | relative claim charge (+0.55), n distinct hcps (-0.38), organ system count (+0.15) |
| F331 | Major depressive disorder, recurrent, moderate | CC | 0.009 | 4428 | work rvu (-0.25), n distinct rev codes (+0.24), n distinct hcps (-0.22) |
| F439 | Reaction to severe stress, unspecified | No CC/MCC | 0.002 | 921 | relative claim charge (+0.44), work rvu (-0.39), n distinct hcps (-0.26) |
| F4310 | Post-traumatic stress disorder, unspecified | No CC/MCC | -0.067 | 2239 | n distinct rev codes (+0.36), relative claim charge (-0.13), work rvu (-0.13) |
Tier 3 (n=1 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| F50012 | Anorexia nervosa, restricting type, severe | No CC/MCC | 5.464 | 945 | work rvu (+1.94), n distinct rev codes (+1.50), relative claim charge (+1.49) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| relative claim charge | 16 | 80.000 |
| work rvu | 14 | 70.000 |
| n distinct rev codes | 13 | 65.000 |
| n distinct hcps | 10 | 50.000 |
| organ system count | 7 | 35.000 |
