OP - DE.0.fine_needle_biopsy

CM Codes

Data Overview

6145 total codes in komodo_rii; 56 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	53
CC	3

PCA Analysis

PC1 explains 38.6% of variance; PC1+PC2 together explain 64.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	organ system count	n distinct rev codes	work rvu	n j code lines	relative claim charge	or	n imaging lines	n distinct hcps
1	17.000	259130.000	1.493	2.924	3.703	0.188	0.972	0.608	0.007	0.786
2	14.000	34191.000	1.955	3.440	4.039	0.240	1.055	0.619	0.028	0.782
3	25.000	47164.000	3.070	3.868	4.213	0.460	1.143	0.701	0.030	0.794

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	0	0	3	3
No CC/MCC	17	14	22	53
All	17	14	25	56

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.506	-0.167	0.159
avg_n_j_code_lines	0.419	0.059	-0.076
avg_organ_system_count	0.406	-0.052	-0.155
avg_relative_claim_charge	0.406	-0.073	0.385
rate_or	0.279	0.072	-0.262
avg_n_imaging_lines	0.278	-0.122	0.312
avg_work_rvu	0.207	0.039	0.390
rate_transfusion	0.199	0.064	0.054
avg_n_distinct_hcps	0.035	-0.184	0.145
avg_length_of_stay	-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

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	3.486	3	1133	n distinct rev codes (+0.97), n j code lines (+0.80), organ system count (+0.67)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	3.092	3	831	organ system count (+0.79), n distinct rev codes (+0.73), n j code lines (+0.48)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	2.761	3	1421	n distinct rev codes (+0.70), organ system count (+0.47), n j code lines (+0.44)
F419	Anxiety disorder, unspecified	No CC/MCC	2.628	3	1254	n j code lines (+0.94), organ system count (+0.57), n distinct rev codes (+0.52)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	2.449	3	626	n distinct rev codes (+0.71), organ system count (+0.66), transfusion (+0.61)

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

None.

Top Codes by Tier

Tier 1 (n=17 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E559	Vitamin D deficiency, unspecified	No CC/MCC	-1.506	1188	or (-0.34), relative claim charge (-0.31), n j code lines (-0.27)
D34	Benign neoplasm of thyroid gland	No CC/MCC	-1.516	11711	n distinct rev codes (-0.72), or (+0.46), n j code lines (-0.39)
E063	Autoimmune thyroiditis	No CC/MCC	-1.570	2462	n distinct rev codes (-0.48), organ system count (-0.37), n imaging lines (-0.31)
K116	Mucocele of salivary gland	No CC/MCC	-1.664	630	relative claim charge (-0.48), organ system count (-0.37), n j code lines (-0.22)
E0500	Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm	No CC/MCC	-1.703	514	transfusion (+0.68), n distinct rev codes (-0.56), or (-0.56)
D440	Neoplasm of uncertain behavior of thyroid gland	No CC/MCC	-1.828	5098	n distinct rev codes (-0.65), relative claim charge (-0.39), n j code lines (-0.29)
E079	Disorder of thyroid, unspecified	No CC/MCC	-1.836	3307	n distinct rev codes (-0.50), organ system count (-0.38), n j code lines (-0.29)
E042	Nontoxic multinodular goiter	No CC/MCC	-1.839	70165	n distinct rev codes (-0.65), organ system count (-0.42), n j code lines (-0.38)
E0789	Other specified disorders of thyroid	No CC/MCC	-2.075	2038	n distinct rev codes (-0.45), organ system count (-0.41), n j code lines (-0.34)
D497	Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system	No CC/MCC	-2.319	565	n distinct rev codes (-0.65), relative claim charge (-0.58), n j code lines (-0.35)

Tier 2 (n=14 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C07	Malignant neoplasm of parotid gland	No CC/MCC	0.594	693	relative claim charge (+0.42), n j code lines (-0.40), n imaging lines (+0.39)
E782	Mixed hyperlipidemia	No CC/MCC	0.326	876	organ system count (+0.31), n imaging lines (-0.26), or (+0.22)
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	-0.233	633	organ system count (+0.20), or (-0.18), work rvu (-0.14)
E210	Primary hyperparathyroidism	No CC/MCC	-0.272	937	n imaging lines (+0.91), or (-0.70), n j code lines (-0.44)
M810	Age-related osteoporosis without current pathological fracture	No CC/MCC	-0.303	897	organ system count (+0.43), relative claim charge (-0.38), n imaging lines (-0.25)
E890	Postprocedural hypothyroidism	No CC/MCC	-0.576	1830	or (-0.23), organ system count (-0.21), n imaging lines (+0.13)
E039	Hypothyroidism, unspecified	No CC/MCC	-0.700	3162	relative claim charge (-0.27), n j code lines (+0.12), n imaging lines (-0.11)
K119	Disease of salivary gland, unspecified	No CC/MCC	-0.804	1065	organ system count (-0.32), n j code lines (-0.22), transfusion (-0.09)
D110	Benign neoplasm of parotid gland	No CC/MCC	-0.826	3095	n j code lines (-0.27), organ system count (-0.26), relative claim charge (-0.22)
D490	Neoplasm of unspecified behavior of digestive system	No CC/MCC	-0.875	787	n j code lines (-0.32), organ system count (-0.29), relative claim charge (-0.20)

Tier 3 (n=25 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	3.486	1133	n distinct rev codes (+0.97), n j code lines (+0.80), organ system count (+0.67)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	3.092	831	organ system count (+0.79), n distinct rev codes (+0.73), n j code lines (+0.48)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	2.761	1421	n distinct rev codes (+0.70), organ system count (+0.47), n j code lines (+0.44)
F419	Anxiety disorder, unspecified	No CC/MCC	2.628	1254	n j code lines (+0.94), organ system count (+0.57), n distinct rev codes (+0.52)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	2.449	626	n distinct rev codes (+0.71), organ system count (+0.66), transfusion (+0.61)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	2.405	1032	organ system count (+0.71), n j code lines (+0.68), relative claim charge (+0.56)
D360	Benign neoplasm of lymph nodes	No CC/MCC	2.260	832	relative claim charge (+0.77), or (+0.73), transfusion (+0.61)
G4730	Sleep apnea, unspecified	No CC/MCC	2.244	627	n j code lines (+0.74), organ system count (+0.71), n distinct rev codes (+0.53)
F32A	Depression, unspecified	No CC/MCC	2.152	902	organ system count (+0.66), n j code lines (+0.64), n distinct rev codes (+0.45)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	1.863	1032	organ system count (+0.77), n distinct rev codes (+0.54), or (+0.44)

Key Driver Frequency

feature	count	pct
n j code lines	40	71.400
n distinct rev codes	37	66.100
organ system count	34	60.700
relative claim charge	22	39.300
or	15	26.800
n imaging lines	11	19.600
work rvu	5	8.900
transfusion	4	7.100