OP - EM.0.critical_care

CM Codes

Data Overview

12696 total codes in komodo_rii; 240 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	179
CC	46
MCC	15

PCA Analysis

PC1 explains 27.5% of variance; PC1+PC2 together explain 50.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n imaging lines	organ system count	n j code lines	relative claim charge	n distinct hcps	transfusion
1	34.000	48288.000	6.323	5.990	0.187	2.229	2.625	0.771	0.671	0.006
2	159.000	475675.000	7.469	8.656	0.842	3.537	2.249	1.043	0.536	0.069
3	47.000	54748.000	10.021	8.766	2.506	2.983	1.977	1.415	0.659	0.017

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	12	29	5	46
MCC	2	12	1	15
No CC/MCC	20	118	41	179
All	34	159	47	240

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.522	-0.091	-0.152
avg_n_imaging_lines	0.519	-0.046	-0.324
avg_work_rvu	0.516	-0.092	-0.265
avg_n_distinct_rev_codes	0.330	-0.022	0.205
rate_or	0.119	0.110	0.117
avg_organ_system_count	0.106	0.069	-0.010
avg_n_distinct_hcps	0.062	-0.067	-0.241
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_mechanical_ventilation	-0.046	0.287	0.070
rate_transfusion	-0.050	0.189	-0.087
rate_dialysis	-0.066	0.079	0.097
rate_icu	-0.084	0.031	0.155
avg_n_j_code_lines	-0.193	0.002	0.129

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
S0181XA	Laceration without foreign body of other part of head, initial encounter	No CC/MCC	4.082	3	2086	work rvu (+1.37), n imaging lines (+1.13), relative claim charge (+0.97)
S022XXA	Fracture of nasal bones, initial encounter for closed fracture	No CC/MCC	4.060	3	1019	n imaging lines (+1.43), work rvu (+1.37), relative claim charge (+1.02)
G8911	Acute pain due to trauma	No CC/MCC	4.035	3	558	n imaging lines (+1.34), work rvu (+1.14), relative claim charge (+0.77)
M47812	Spondylosis without myelopathy or radiculopathy, cervical region	No CC/MCC	4.009	3	988	n imaging lines (+1.31), work rvu (+1.15), relative claim charge (+0.83)
S301XXA	None	No CC/MCC	4.006	3	741	relative claim charge (+1.37), work rvu (+1.29), n imaging lines (+1.21)

Under-tiered: Tier 1, MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E1010	Type 1 diabetes mellitus with ketoacidosis without coma	MCC	-2.558	1	793	n imaging lines (-0.61), work rvu (-0.48), n j code lines (-0.39)
E1110	Type 2 diabetes mellitus with ketoacidosis without coma	MCC	-1.684	1	519	n imaging lines (-0.42), n j code lines (-0.33), relative claim charge (-0.31)

Top Codes by Tier

Tier 1 (n=34 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K3184	Gastroparesis	No CC/MCC	-1.642	554	n j code lines (-0.61), relative claim charge (-0.36), n imaging lines (-0.32)
E1110	Type 2 diabetes mellitus with ketoacidosis without coma	MCC	-1.684	519	n imaging lines (-0.42), n j code lines (-0.33), relative claim charge (-0.31)
I4719	Other supraventricular tachycardia	No CC/MCC	-1.737	711	n imaging lines (-0.53), relative claim charge (-0.49), work rvu (-0.47)
J209	Acute bronchitis, unspecified	No CC/MCC	-1.752	610	relative claim charge (-0.64), work rvu (-0.57), n imaging lines (-0.49)
T50901A	Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter	No CC/MCC	-1.805	506	relative claim charge (-0.60), n distinct rev codes (-0.52), work rvu (-0.45)
J029	Acute pharyngitis, unspecified	No CC/MCC	-1.855	818	relative claim charge (-0.55), work rvu (-0.52), n imaging lines (-0.42)
F10239	Alcohol dependence with withdrawal, unspecified	CC	-1.856	548	n j code lines (-0.58), n imaging lines (-0.34), relative claim charge (-0.32)
B349	Viral infection, unspecified	No CC/MCC	-1.891	798	work rvu (-0.59), relative claim charge (-0.55), n imaging lines (-0.51)
T402X1A	Poisoning by other opioids, accidental (unintentional), initial encounter	No CC/MCC	-1.896	818	relative claim charge (-0.61), work rvu (-0.42), n distinct rev codes (-0.40)
F840	Autistic disorder	CC	-1.941	681	n distinct rev codes (-0.65), relative claim charge (-0.58), work rvu (-0.51)

Tier 2 (n=159 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J90	Pleural effusion, not elsewhere classified	CC	1.253	1759	or (+0.81), n distinct rev codes (+0.25), relative claim charge (+0.12)
G9341	Metabolic encephalopathy	MCC	1.185	832	n distinct rev codes (+0.54), relative claim charge (+0.48), n imaging lines (+0.24)
G43909	Migraine, unspecified, not intractable, without status migrainosus	No CC/MCC	1.150	1499	work rvu (+0.56), n imaging lines (+0.52), n j code lines (-0.37)
F10120	Alcohol abuse with intoxication, uncomplicated	No CC/MCC	1.118	909	relative claim charge (+0.55), n imaging lines (+0.39), work rvu (+0.35)
N200	Calculus of kidney	No CC/MCC	1.104	615	relative claim charge (+0.45), work rvu (+0.40), n imaging lines (+0.30)
F0390	Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety	No CC/MCC	1.100	1869	n imaging lines (+0.36), n j code lines (+0.27), relative claim charge (+0.16)
F0280	Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety	No CC/MCC	1.080	536	n imaging lines (+0.32), n j code lines (+0.28), organ system count (+0.19)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	1.011	894	relative claim charge (+0.39), n distinct rev codes (+0.30), n imaging lines (+0.21)
I469	Cardiac arrest, cause unspecified	MCC	0.885	1200	work rvu (+1.45), or (+1.07), n distinct rev codes (-0.66)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	0.875	1144	work rvu (+0.42), n j code lines (-0.38), relative claim charge (+0.35)

Tier 3 (n=47 codes)

code	Description	CMS severity	Score	N claims	Key drivers
S0181XA	Laceration without foreign body of other part of head, initial encounter	No CC/MCC	4.082	2086	work rvu (+1.37), n imaging lines (+1.13), relative claim charge (+0.97)
S022XXA	Fracture of nasal bones, initial encounter for closed fracture	No CC/MCC	4.060	1019	n imaging lines (+1.43), work rvu (+1.37), relative claim charge (+1.02)
G8911	Acute pain due to trauma	No CC/MCC	4.035	558	n imaging lines (+1.34), work rvu (+1.14), relative claim charge (+0.77)
M47812	Spondylosis without myelopathy or radiculopathy, cervical region	No CC/MCC	4.009	988	n imaging lines (+1.31), work rvu (+1.15), relative claim charge (+0.83)
S301XXA	None	No CC/MCC	4.006	741	relative claim charge (+1.37), work rvu (+1.29), n imaging lines (+1.21)
S01511A	Laceration without foreign body of lip, initial encounter	No CC/MCC	3.936	674	work rvu (+1.47), n imaging lines (+1.24), relative claim charge (+0.95)
S80211A	Abrasion, right knee, initial encounter	No CC/MCC	3.885	1049	work rvu (+1.25), n imaging lines (+1.18), relative claim charge (+1.11)
S069X9A	Unspecified intracranial injury with loss of consciousness of unspecified duration, initial encounter	CC	3.865	546	n imaging lines (+1.33), work rvu (+1.20), relative claim charge (+0.87)
S80212A	Abrasion, left knee, initial encounter	No CC/MCC	3.839	1083	work rvu (+1.20), relative claim charge (+1.17), n imaging lines (+1.15)
G459	Transient cerebral ischemic attack, unspecified	CC	3.749	2693	n imaging lines (+1.20), work rvu (+1.15), relative claim charge (+0.79)

Key Driver Frequency

feature	count	pct
work rvu	174	72.500
n imaging lines	169	70.400
relative claim charge	164	68.300
n distinct rev codes	95	39.600
n j code lines	61	25.400
organ system count	26	10.800
or	9	3.800
dialysis	7	2.900
transfusion	7	2.900
mechanical ventilation	4	1.700
icu	3	1.200
n distinct hcps	1	0.400