OP - CA.0.PCI

CM Codes

Data Overview

4055 total codes in komodo_rii; 116 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	89
CC	25
MCC	2

PCA Analysis

PC1 explains 19.2% of variance; PC1+PC2 together explain 33.0%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	organ system count	work rvu	n distinct rev codes	n distinct hcps	n j code lines	relative claim charge	dialysis	or
1	4.000	3557.000	2.575	9.671	9.269	0.749	5.782	0.964	0.000	0.043
2	41.000	387507.000	2.736	9.517	9.409	0.639	5.629	1.007	0.001	0.047
3	38.000	160107.000	3.103	9.173	9.483	0.613	5.637	1.015	0.001	0.054
4	23.000	58516.000	3.595	8.872	9.580	0.593	5.678	1.012	0.004	0.060
5	10.000	15875.000	3.859	9.309	9.730	0.566	5.661	1.031	0.018	0.058

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	2	8	10	3	2	25
MCC	0	0	0	0	2	2
No CC/MCC	2	33	28	20	6	89
All	4	41	38	23	10	116

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_organ_system_count	0.420	-0.065	-0.188
rate_transfusion	0.330	0.118	-0.052
avg_n_distinct_rev_codes	0.321	-0.249	0.125
rate_dialysis	0.318	-0.086	0.304
rate_or	0.309	0.022	0.185
rate_icu	0.288	0.402	-0.242
avg_n_imaging_lines	0.263	0.155	0.006
avg_relative_claim_charge	0.160	-0.061	0.032
avg_length_of_stay	0.000	nan	nan
avg_n_j_code_lines	0.000	0.006	-0.122
rate_multiple_or_days	0.000	nan	nan
rate_mechanical_ventilation	-0.039	0.224	-0.104
avg_work_rvu	-0.162	0.075	0.148
avg_n_distinct_hcps	-0.458	-0.039	0.030

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D631	Anemia in chronic kidney disease	No CC/MCC	6.483	5	689	transfusion (+1.78), dialysis (+1.66), organ system count (+1.09)
G8929	Other chronic pain	No CC/MCC	3.494	5	1043	organ system count (+1.07), icu (+1.00), n imaging lines (+0.96)
N182	Chronic kidney disease, stage 2 (mild)	No CC/MCC	3.051	5	764	icu (+1.44), n distinct hcps (+0.61), organ system count (+0.49)
D649	Anemia, unspecified	No CC/MCC	2.987	5	1130	n distinct hcps (+0.75), organ system count (+0.71), transfusion (+0.64)
I700	Atherosclerosis of aorta	No CC/MCC	2.651	5	1287	n imaging lines (+1.12), n distinct rev codes (+0.62), icu (+0.49)

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

None.

Top Codes by Tier

Tier 1 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I2583	Coronary atherosclerosis due to lipid rich plaque	No CC/MCC	-2.320	1598	n distinct hcps (-1.11), organ system count (-0.43), work rvu (-0.35)
I471	None	CC	-2.583	524	n distinct hcps (-1.12), or (-0.43), relative claim charge (-0.34)
Q245	Malformation of coronary vessels	CC	-3.691	704	n distinct hcps (-1.33), n distinct rev codes (-0.50), organ system count (-0.45)
I208	None	No CC/MCC	-3.942	731	n distinct hcps (-1.77), or (-0.44), n distinct rev codes (-0.38)

Tier 2 (n=41 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I429	Cardiomyopathy, unspecified	CC	-0.667	3887	organ system count (-0.39), n distinct rev codes (-0.33), transfusion (+0.19)
E782	Mixed hyperlipidemia	No CC/MCC	-0.733	15486	or (-0.54), transfusion (-0.18), n distinct hcps (+0.16)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	-0.772	63062	organ system count (-0.43), n distinct rev codes (-0.27), n distinct hcps (+0.26)
I4720	Ventricular tachycardia, unspecified	No CC/MCC	-0.777	1570	mechanical ventilation (-0.41), organ system count (-0.35), or (-0.29)
I25119	Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris	No CC/MCC	-0.779	19833	organ system count (-0.40), n distinct hcps (+0.23), n distinct rev codes (-0.21)
I2089	Other forms of angina pectoris	No CC/MCC	-0.803	1242	relative claim charge (+0.45), organ system count (-0.44), or (+0.40)
I25810	Atherosclerosis of coronary artery bypass graft(s) without angina pectoris	CC	-0.819	1489	organ system count (-0.45), or (-0.31), transfusion (-0.27)
E669	Obesity, unspecified	No CC/MCC	-0.841	9303	n distinct rev codes (-0.49), n distinct hcps (-0.24), or (+0.17)
I340	Nonrheumatic mitral (valve) insufficiency	No CC/MCC	-0.859	3691	n distinct hcps (-0.32), organ system count (-0.28), transfusion (-0.27)
I444	Left anterior fascicular block	No CC/MCC	-0.861	633	n distinct rev codes (+0.85), n distinct hcps (-0.61), organ system count (-0.43)

Tier 3 (n=38 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	0.567	2360	organ system count (+0.89), n distinct rev codes (-0.37), or (-0.21)
I5042	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	CC	0.499	1299	n distinct hcps (+0.59), n distinct rev codes (+0.56), or (-0.30)
I200	Unstable angina	CC	0.477	3394	n distinct hcps (+0.74), organ system count (-0.35), or (+0.23)
J439	Emphysema, unspecified	No CC/MCC	0.333	928	organ system count (+0.65), transfusion (-0.27), icu (-0.15)
I495	Sick sinus syndrome	No CC/MCC	0.331	1573	n distinct rev codes (+0.39), n distinct hcps (+0.36), organ system count (-0.28)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	0.313	3182	n imaging lines (+0.26), or (+0.23), n distinct hcps (+0.21)
N189	Chronic kidney disease, unspecified	No CC/MCC	0.295	3970	organ system count (+0.37), work rvu (+0.19), transfusion (-0.17)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	0.269	2442	organ system count (+0.70), transfusion (-0.27), or (+0.20)
E039	Hypothyroidism, unspecified	No CC/MCC	0.223	6090	n imaging lines (+0.23), or (-0.21), n distinct hcps (+0.18)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	0.175	1010	icu (+0.66), n distinct hcps (-0.34), organ system count (+0.31)

Tier 4 (n=23 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M797	Fibromyalgia	No CC/MCC	2.084	502	organ system count (+1.05), transfusion (+0.54), n distinct hcps (+0.37)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	2.012	3287	or (+0.55), organ system count (+0.47), n distinct hcps (+0.26)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	1.878	7820	organ system count (+0.44), dialysis (+0.34), or (+0.32)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	1.836	1512	n distinct rev codes (+1.01), n distinct hcps (+0.68), or (+0.40)
I70213	Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs	No CC/MCC	1.664	615	relative claim charge (+0.70), n distinct rev codes (+0.65), or (+0.29)
N1831	Chronic kidney disease, stage 3a	No CC/MCC	1.641	1432	n distinct hcps (+0.47), organ system count (+0.46), relative claim charge (+0.43)
I080	Rheumatic disorders of both mitral and aortic valves	No CC/MCC	1.640	865	transfusion (+0.93), n imaging lines (+0.39), icu (+0.32)
I350	Nonrheumatic aortic (valve) stenosis	No CC/MCC	1.636	7281	n imaging lines (+1.47), organ system count (-0.34), or (+0.26)
M109	Gout, unspecified	No CC/MCC	1.535	1155	icu (+0.93), organ system count (+0.78), or (+0.35)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	1.495	1434	dialysis (+1.55), or (+0.74), n distinct hcps (-0.49)

Tier 5 (n=10 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D631	Anemia in chronic kidney disease	No CC/MCC	6.483	689	transfusion (+1.78), dialysis (+1.66), organ system count (+1.09)
G8929	Other chronic pain	No CC/MCC	3.494	1043	organ system count (+1.07), icu (+1.00), n imaging lines (+0.96)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	3.492	2198	n distinct hcps (+1.64), icu (+1.14), n imaging lines (+0.69)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	3.440	876	dialysis (+1.76), n distinct rev codes (+0.58), transfusion (+0.43)
N182	Chronic kidney disease, stage 2 (mild)	No CC/MCC	3.051	764	icu (+1.44), n distinct hcps (+0.61), organ system count (+0.49)
D649	Anemia, unspecified	No CC/MCC	2.987	1130	n distinct hcps (+0.75), organ system count (+0.71), transfusion (+0.64)
I700	Atherosclerosis of aorta	No CC/MCC	2.651	1287	n imaging lines (+1.12), n distinct rev codes (+0.62), icu (+0.49)
F32A	Depression, unspecified	No CC/MCC	2.602	1844	organ system count (+0.95), icu (+0.94), n distinct hcps (+0.49)
N186	End stage renal disease	MCC	2.601	2518	dialysis (+1.64), or (+0.54), transfusion (+0.51)
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	2.386	3526	n distinct hcps (+0.86), organ system count (+0.38), transfusion (+0.31)

Key Driver Frequency

feature	count	pct
organ system count	79	68.100
n distinct hcps	69	59.500
n distinct rev codes	53	45.700
or	52	44.800
transfusion	40	34.500
icu	17	14.700
n imaging lines	15	12.900
work rvu	9	7.800
relative claim charge	8	6.900
dialysis	5	4.300
mechanical ventilation	1	0.900

PCS Codes

Data Overview

83 total codes in komodo_rii; 4 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 69.2% of variance; PC1+PC2 together explain 92.7%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	relative claim charge	n j code lines	n distinct hcps	icu	organ system count	n imaging lines
1	1.000	512.000	9.605	11.747	0.798	4.038	0.922	0.042	2.176	0.009
2	1.000	847.000	10.647	12.041	1.013	4.060	0.980	0.019	2.175	0.011
3	2.000	1138.000	10.414	12.112	1.020	4.209	0.986	0.024	2.158	0.015

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.362	0.400
avg_relative_claim_charge	0.356	0.200
rate_mechanical_ventilation	0.354	0.200
avg_n_distinct_hcps	0.350	0.400
avg_work_rvu	0.327	1.000
avg_n_j_code_lines	0.281	0.400
rate_or	0.268	0.400
avg_n_imaging_lines	0.210	0.400
avg_length_of_stay	-0.000	nan
rate_dialysis	-0.000	nan
rate_multiple_or_days	-0.000	nan
avg_organ_system_count	-0.075	0.000
rate_icu	-0.247	-0.400
rate_transfusion	-0.354	-0.775

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
027034Z	DILATION OF CORONARY ARTERY, ONE ARTERY WITH DRUG-ELUTING INTRALUMINAL DEVICE, PERCUTANEOUS APPROACH	-4.676	512	relative claim charge (-0.62), transfusion (-0.61), n distinct rev codes (-0.61)

Tier 2 (n=1 codes)

code	Description	Score	N claims	Key drivers
4A023N7	MEASUREMENT OF CARDIAC SAMPLING AND PRESSURE, LEFT HEART, PERCUTANEOUS APPROACH	0.669	847	work rvu (+0.31), n j code lines (-0.23), transfusion (+0.20)

Tier 3 (n=2 codes)

code	Description	Score	N claims	Key drivers
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	2.263	599	or (+0.44), n j code lines (+0.38), n imaging lines (+0.36)
B2151ZZ	FLUOROSCOPY OF LEFT HEART USING LOW OSMOLAR CONTRAST	1.744	539	mechanical ventilation (+0.34), n distinct hcps (+0.31), icu (+0.28)

Key Driver Frequency

feature	count	pct
n j code lines	2	50.000
transfusion	2	50.000
work rvu	1	25.000
mechanical ventilation	1	25.000
n distinct hcps	1	25.000
icu	1	25.000
or	1	25.000
n imaging lines	1	25.000
relative claim charge	1	25.000
n distinct rev codes	1	25.000