OP - EM.0.ER

CM Codes

Data Overview

44320 total codes in komodo_rii; 326 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	288
CC	34
MCC	4

PCA Analysis

PC1 explains 37.6% of variance; PC1+PC2 together explain 56.4%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	work rvu	organ system count	n j code lines	relative claim charge	n imaging lines	n distinct hcps	transfusion
1	57.000	13798869.000	2.845	2.417	1.876	0.436	0.625	0.111	0.740	0.000
2	106.000	30032314.000	4.273	3.515	2.042	0.736	0.988	0.316	0.729	0.001
3	105.000	55046302.000	5.319	4.344	2.759	1.014	1.319	0.677	0.713	0.001
4	58.000	11375884.000	6.564	5.001	3.137	1.431	1.581	0.710	0.686	0.007

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	2	10	5	17	34
MCC	0	1	2	1	4
No CC/MCC	55	95	98	40	288
All	57	106	105	58	326

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.432	0.149	0.242
avg_relative_claim_charge	0.408	0.040	0.092
avg_work_rvu	0.407	0.023	0.089
avg_n_j_code_lines	0.309	0.145	0.194
avg_organ_system_count	0.309	0.127	0.002
rate_icu	0.296	0.142	0.229
avg_n_imaging_lines	0.267	-0.005	-0.062
rate_transfusion	0.188	0.135	0.140
rate_dialysis	0.147	0.178	0.139
rate_mechanical_ventilation	0.091	0.265	0.153
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_or	-0.022	-0.048	-0.065
avg_n_distinct_hcps	-0.257	-0.233	-0.215

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, 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	8.034	4	82305	icu (+1.85), transfusion (+1.74), dialysis (+1.71)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	4.504	4	204149	relative claim charge (+1.22), work rvu (+1.01), n distinct rev codes (+0.90)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	4.440	4	163836	relative claim charge (+1.05), work rvu (+0.90), n distinct rev codes (+0.89)
E8342	Hypomagnesemia	No CC/MCC	4.282	4	220221	n distinct rev codes (+0.88), n j code lines (+0.76), n distinct hcps (+0.72)
N281	Cyst of kidney, acquired	No CC/MCC	4.266	4	115347	relative claim charge (+1.12), work rvu (+1.01), n distinct rev codes (+0.86)

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

None.

Top Codes by Tier

Tier 1 (n=57 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J219	Acute bronchiolitis, unspecified	CC	-2.101	119735	work rvu (-0.51), n distinct rev codes (-0.45), organ system count (-0.44)
B9789	Other viral agents as the cause of diseases classified elsewhere	No CC/MCC	-2.130	276080	work rvu (-0.64), relative claim charge (-0.48), n distinct rev codes (-0.47)
M25572	Pain in left ankle and joints of left foot	No CC/MCC	-2.265	249782	n distinct rev codes (-0.46), relative claim charge (-0.35), n j code lines (-0.33)
M25571	Pain in right ankle and joints of right foot	No CC/MCC	-2.321	259537	n distinct rev codes (-0.46), relative claim charge (-0.35), work rvu (-0.33)
T7840XA	Allergy, unspecified, initial encounter	No CC/MCC	-2.325	300526	relative claim charge (-0.63), work rvu (-0.57), n distinct rev codes (-0.54)
B349	Viral infection, unspecified	No CC/MCC	-2.365	1179316	work rvu (-0.54), relative claim charge (-0.43), n distinct rev codes (-0.30)
O26893	Other specified pregnancy related conditions, third trimester	No CC/MCC	-2.389	174935	organ system count (-0.70), relative claim charge (-0.41), n distinct rev codes (-0.36)
M79671	Pain in right foot	No CC/MCC	-2.420	301476	n distinct rev codes (-0.49), relative claim charge (-0.49), work rvu (-0.48)
L500	Allergic urticaria	No CC/MCC	-2.423	74454	relative claim charge (-0.66), work rvu (-0.60), n distinct rev codes (-0.58)
M79672	Pain in left foot	No CC/MCC	-2.448	293572	relative claim charge (-0.49), n distinct rev codes (-0.48), work rvu (-0.47)

Tier 2 (n=106 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G510	Bell's palsy	No CC/MCC	-0.093	77730	n imaging lines (+0.26), organ system count (-0.15), work rvu (+0.14)
M5450	Low back pain, unspecified	No CC/MCC	-0.112	1771115	icu (-0.16), n j code lines (+0.13), n imaging lines (+0.10)
M109	Gout, unspecified	No CC/MCC	-0.159	208422	organ system count (+0.28), work rvu (-0.22), relative claim charge (-0.20)
E109	Type 1 diabetes mellitus without complications	No CC/MCC	-0.160	87713	n j code lines (+0.15), n imaging lines (-0.11), icu (-0.06)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-0.203	4544224	organ system count (+0.11), relative claim charge (-0.10), work rvu (-0.09)
F411	Generalized anxiety disorder	No CC/MCC	-0.207	199821	n distinct hcps (+0.32), n imaging lines (-0.17), relative claim charge (-0.15)
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	-0.279	991003	n distinct hcps (+0.20), work rvu (-0.16), relative claim charge (-0.11)
M5412	Radiculopathy, cervical region	No CC/MCC	-0.306	141451	organ system count (-0.15), icu (-0.13), n j code lines (+0.13)
F4310	Post-traumatic stress disorder, unspecified	No CC/MCC	-0.309	138075	organ system count (+0.17), n imaging lines (-0.14), n distinct hcps (-0.14)
K6289	Other specified diseases of anus and rectum	No CC/MCC	-0.356	99499	icu (-0.15), organ system count (-0.14), n j code lines (+0.10)

Tier 3 (n=105 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	2.010	227595	organ system count (+0.57), n distinct rev codes (+0.41), work rvu (+0.30)
I517	Cardiomegaly	No CC/MCC	1.980	99133	n distinct rev codes (+0.79), work rvu (+0.63), relative claim charge (+0.60)
I440	Atrioventricular block, first degree	No CC/MCC	1.979	109565	n distinct rev codes (+0.79), work rvu (+0.57), relative claim charge (+0.45)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	1.972	1453602	organ system count (+0.42), n distinct rev codes (+0.41), n distinct hcps (+0.31)
I110	Hypertensive heart disease with heart failure	No CC/MCC	1.967	778646	n distinct rev codes (+0.47), n distinct hcps (+0.41), organ system count (+0.32)
F0280	Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety	No CC/MCC	1.963	85175	organ system count (+0.73), n distinct rev codes (+0.46), work rvu (+0.44)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	1.949	721711	organ system count (+0.66), n distinct rev codes (+0.39), n distinct hcps (+0.32)
G309	Alzheimer's disease, unspecified	No CC/MCC	1.902	78647	organ system count (+0.69), n distinct rev codes (+0.45), work rvu (+0.41)
G20A1	Parkinson's disease without dyskinesia, without mention of fluctuations	No CC/MCC	1.901	78973	organ system count (+0.46), work rvu (+0.38), n distinct rev codes (+0.37)
E860	Dehydration	No CC/MCC	1.884	1044910	n distinct rev codes (+0.64), n j code lines (+0.49), relative claim charge (+0.32)

Tier 4 (n=58 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D631	Anemia in chronic kidney disease	No CC/MCC	8.034	82305	icu (+1.85), transfusion (+1.74), dialysis (+1.71)
N179	Acute kidney failure, unspecified	CC	5.915	284606	icu (+1.51), n distinct hcps (+0.98), n distinct rev codes (+0.88)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	4.504	204149	relative claim charge (+1.22), work rvu (+1.01), n distinct rev codes (+0.90)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	4.440	163836	relative claim charge (+1.05), work rvu (+0.90), n distinct rev codes (+0.89)
E8342	Hypomagnesemia	No CC/MCC	4.282	220221	n distinct rev codes (+0.88), n j code lines (+0.76), n distinct hcps (+0.72)
N281	Cyst of kidney, acquired	No CC/MCC	4.266	115347	relative claim charge (+1.12), work rvu (+1.01), n distinct rev codes (+0.86)
E875	Hyperkalemia	No CC/MCC	4.209	102138	icu (+1.49), dialysis (+0.70), n distinct rev codes (+0.62)
I160	Hypertensive urgency	No CC/MCC	4.186	114208	icu (+1.39), n distinct hcps (+0.87), n distinct rev codes (+0.71)
I5032	Chronic diastolic (congestive) heart failure	CC	3.986	147251	icu (+1.12), n distinct hcps (+0.86), n distinct rev codes (+0.56)
E871	Hypo-osmolality and hyponatremia	CC	3.891	295613	icu (+1.30), n distinct rev codes (+0.74), work rvu (+0.42)

Key Driver Frequency

feature	count	pct
n distinct rev codes	209	64.100
relative claim charge	179	54.900
work rvu	159	48.800
organ system count	105	32.200
n distinct hcps	87	26.700
n j code lines	84	25.800
n imaging lines	81	24.800
icu	56	17.200
transfusion	10	3.100
dialysis	5	1.500
mechanical ventilation	3	0.900