OP - CO.0.IV_infusion

CM Codes

Data Overview

19300 total codes in komodo_rii; 304 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	189
CC	103
MCC	12

PCA Analysis

PC1 explains 34.5% of variance; PC1+PC2 together explain 50.5%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	n distinct rev codes	organ system count	relative claim charge	n distinct hcps	n imaging lines	or
1	102.000	1789180.000	0.551	2.006	2.960	1.789	1.002	0.577	0.005	0.004
2	125.000	1084344.000	1.245	2.694	3.598	2.435	1.171	0.480	0.019	0.011
3	75.000	748169.000	2.718	2.838	4.088	3.509	1.348	0.317	0.062	0.011
4	2.000	5069.000	8.014	6.381	5.336	2.925	2.093	0.111	0.079	0.032

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	32	58	12	1	103
MCC	3	2	6	1	12
No CC/MCC	67	65	57	0	189
All	102	125	75	2	304

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.394	-0.052	-0.118
avg_n_imaging_lines	0.367	-0.037	-0.108
rate_icu	0.362	0.173	-0.078
avg_organ_system_count	0.355	0.086	-0.265
avg_n_distinct_rev_codes	0.307	0.058	-0.045
rate_mechanical_ventilation	0.278	0.207	-0.067
avg_n_j_code_lines	0.253	-0.073	0.036
avg_relative_claim_charge	0.251	-0.065	0.017
rate_or	0.140	0.103	-0.078
rate_dialysis	0.083	0.160	-0.133
rate_transfusion	0.083	0.040	0.019
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_n_distinct_hcps	-0.347	0.038	-0.022

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, 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
I330	Acute and subacute infective endocarditis	MCC	-2.635	1	3851	n distinct hcps (-0.46), work rvu (-0.36), organ system count (-0.33)
K750	Abscess of liver	MCC	-2.502	1	3165	organ system count (-0.38), work rvu (-0.35), n j code lines (-0.34)
K651	Peritoneal abscess	MCC	-1.833	1	3935	organ system count (-0.39), work rvu (-0.28), n distinct hcps (-0.27)

Top Codes by Tier

Tier 1 (n=102 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G309	Alzheimer's disease, unspecified	No CC/MCC	-1.064	2494	n distinct hcps (+0.71), n distinct rev codes (-0.50), n j code lines (-0.38)
K5090	Crohn's disease, unspecified, without complications	CC	-1.120	7552	n distinct rev codes (-0.43), organ system count (-0.29), n j code lines (-0.28)
C569	Malignant neoplasm of unspecified ovary	CC	-1.131	5962	n distinct hcps (-0.28), n j code lines (+0.28), organ system count (-0.28)
K5792	Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding	CC	-1.132	4892	organ system count (-0.25), relative claim charge (-0.25), icu (-0.22)
D472	Monoclonal gammopathy	No CC/MCC	-1.134	5111	n imaging lines (-0.28), work rvu (-0.25), icu (-0.22)
M0579	Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement	No CC/MCC	-1.139	4882	relative claim charge (+0.91), organ system count (-0.48), n distinct rev codes (-0.48)
D839	Common variable immunodeficiency, unspecified	CC	-1.170	3651	relative claim charge (+0.79), n distinct rev codes (-0.71), organ system count (-0.43)
C159	Malignant neoplasm of esophagus, unspecified	CC	-1.179	2515	n j code lines (+0.32), organ system count (-0.29), n distinct rev codes (-0.25)
C50212	Malignant neoplasm of upper-inner quadrant of left female breast	No CC/MCC	-1.190	3206	n imaging lines (-0.27), work rvu (-0.25), icu (-0.22)
T148XXA	Other injury of unspecified body region, initial encounter	No CC/MCC	-1.236	2497	n distinct hcps (-0.52), icu (-0.22), n j code lines (-0.21)

Tier 2 (n=125 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1142	Type 2 diabetes mellitus with diabetic polyneuropathy	No CC/MCC	1.204	5047	organ system count (+0.54), n distinct rev codes (+0.26), n distinct hcps (+0.23)
J020	Streptococcal pharyngitis	No CC/MCC	1.197	2405	work rvu (+0.68), n distinct hcps (+0.60), n imaging lines (+0.56)
M79604	Pain in right leg	No CC/MCC	1.180	2578	mechanical ventilation (+0.64), work rvu (+0.23), organ system count (+0.20)
I5022	Chronic systolic (congestive) heart failure	CC	1.161	5083	icu (+0.69), n distinct rev codes (+0.31), n distinct hcps (+0.18)
E8339	Other disorders of phosphorus metabolism	No CC/MCC	1.151	4755	or (+0.70), n distinct rev codes (+0.42), n distinct hcps (-0.24)
N200	Calculus of kidney	No CC/MCC	1.149	4876	work rvu (+0.74), n distinct hcps (+0.49), n imaging lines (+0.30)
G43909	Migraine, unspecified, not intractable, without status migrainosus	No CC/MCC	1.122	8673	n imaging lines (+0.59), work rvu (+0.42), n j code lines (+0.41)
I951	Orthostatic hypotension	No CC/MCC	1.116	2848	or (+0.53), organ system count (+0.33), n distinct rev codes (+0.30)
K7460	Unspecified cirrhosis of liver	No CC/MCC	1.106	4596	icu (+0.48), organ system count (+0.22), n distinct hcps (+0.19)
M7910	Myalgia, unspecified site	No CC/MCC	1.048	2568	work rvu (+0.45), n imaging lines (+0.33), n distinct hcps (+0.25)

Tier 3 (n=75 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F319	Bipolar disorder, unspecified	No CC/MCC	4.842	3112	work rvu (+0.80), mechanical ventilation (+0.78), n imaging lines (+0.73)
E8720	Acidosis, unspecified	No CC/MCC	4.170	5719	mechanical ventilation (+1.06), icu (+1.04), n imaging lines (+0.46)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	4.108	8022	organ system count (+0.94), icu (+0.89), work rvu (+0.50)
J441	Chronic obstructive pulmonary disease with (acute) exacerbation	CC	4.085	5916	n distinct hcps (+0.79), n distinct rev codes (+0.77), n imaging lines (+0.58)
F1010	Alcohol abuse, uncomplicated	No CC/MCC	3.990	2435	work rvu (+0.84), n imaging lines (+0.79), icu (+0.69)
K8020	Calculus of gallbladder without cholecystitis without obstruction	No CC/MCC	3.897	2637	work rvu (+1.06), n imaging lines (+0.67), mechanical ventilation (+0.59)
G40909	Epilepsy, unspecified, not intractable, without status epilepticus	No CC/MCC	3.865	6812	n imaging lines (+1.93), work rvu (+0.52), mechanical ventilation (+0.48)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	3.599	8531	icu (+0.88), work rvu (+0.69), organ system count (+0.55)
E669	Obesity, unspecified	No CC/MCC	3.537	11620	work rvu (+0.77), relative claim charge (+0.58), icu (+0.52)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	3.475	2431	icu (+1.94), n distinct rev codes (+0.68), organ system count (+0.43)

Tier 4 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9601	Acute respiratory failure with hypoxia	MCC	12.299	2517	mechanical ventilation (+4.07), icu (+3.53), n distinct rev codes (+1.01)
K3580	Unspecified acute appendicitis	CC	9.075	2552	work rvu (+3.54), n j code lines (+2.09), relative claim charge (+1.09)

Key Driver Frequency

feature	count	pct
organ system count	162	53.300
work rvu	154	50.700
n distinct hcps	141	46.400
n distinct rev codes	120	39.500
n imaging lines	104	34.200
icu	75	24.700
n j code lines	69	22.700
relative claim charge	48	15.800
or	14	4.600
transfusion	12	3.900
mechanical ventilation	11	3.600
dialysis	2	0.700