OP - BE.0.substance_abuse

CM Codes

Data Overview

902 total codes in komodo_rii; 10 retained after n_claims > 500 filter.

CMS severity	n codes
CC	6
No CC/MCC	4

PCA Analysis

PC1 explains 50.5% of variance; PC1+PC2 together explain 88.8%.

Tier Clustering (k=5)

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	2.000	1562.000	0.669	0.958	0.050	1.005	1.011	0.002	0.000	0.000
2	2.000	1954.000	0.672	0.979	0.073	0.997	1.020	0.002	0.000	0.000
3	2.000	3052.000	0.570	0.929	0.099	1.014	1.015	0.004	0.000	0.000
4	2.000	8126.000	0.633	0.998	0.069	1.002	1.025	0.000	0.000	0.000
5	2.000	1692.000	0.557	1.007	0.108	1.033	1.019	0.000	0.000	0.000

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	2	2	2	0	0	6
No CC/MCC	0	0	0	2	2	4
All	2	2	2	2	2	10

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.454	-0.300	-0.289
avg_work_rvu	0.453	0.100	-0.289
avg_n_distinct_rev_codes	0.373	0.000	-0.866
avg_organ_system_count	0.288	0.700	-0.577
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	-0.415	0.000	0.866
avg_n_distinct_hcps	-0.441	-0.100	0.577

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
F1220	Cannabis dependence, uncomplicated	No CC/MCC	3.025	5	846	relative claim charge (+0.81), work rvu (+0.61), n distinct hcps (+0.58)
F1220	Cannabis dependence, uncomplicated	No CC/MCC	3.025	5	846	relative claim charge (+0.81), work rvu (+0.61), n distinct hcps (+0.58)

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

None.

Top Codes by Tier

Tier 1 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F1420	Cocaine dependence, uncomplicated	CC	-2.154	781	work rvu (-0.64), n distinct hcps (-0.44), organ system count (-0.42)
F1420	Cocaine dependence, uncomplicated	CC	-2.154	781	work rvu (-0.64), n distinct hcps (-0.44), organ system count (-0.42)

Tier 2 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F1520	Other stimulant dependence, uncomplicated	CC	-0.998	977	relative claim charge (-0.48), n distinct hcps (-0.47), work rvu (-0.15)
F1520	Other stimulant dependence, uncomplicated	CC	-0.998	977	relative claim charge (-0.48), n distinct hcps (-0.47), work rvu (-0.15)

Tier 3 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F1120	Opioid dependence, uncomplicated	CC	-0.365	1526	n j code lines (-0.60), n distinct rev codes (-0.59), n distinct hcps (+0.46)
F1120	Opioid dependence, uncomplicated	CC	-0.365	1526	n j code lines (-0.60), n distinct rev codes (-0.59), n distinct hcps (+0.46)

Tier 4 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F1020	Alcohol dependence, uncomplicated	No CC/MCC	0.491	4063	organ system count (+0.42), n j code lines (+0.39), n distinct rev codes (+0.32)
F1020	Alcohol dependence, uncomplicated	No CC/MCC	0.491	4063	organ system count (+0.42), n j code lines (+0.39), n distinct rev codes (+0.32)

Tier 5 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F1220	Cannabis dependence, uncomplicated	No CC/MCC	3.025	846	relative claim charge (+0.81), work rvu (+0.61), n distinct hcps (+0.58)
F1220	Cannabis dependence, uncomplicated	No CC/MCC	3.025	846	relative claim charge (+0.81), work rvu (+0.61), n distinct hcps (+0.58)

Key Driver Frequency

feature	count	pct
n distinct hcps	8	80.000
work rvu	6	60.000
organ system count	4	40.000
relative claim charge	4	40.000
n j code lines	4	40.000
n distinct rev codes	4	40.000