OP - GA.0.appendectomy

CM Codes

Data Overview

3855 total codes in komodo_rii; 47 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	39
CC	6
MCC	2

PCA Analysis

PC1 explains 39.5% of variance; PC1+PC2 together explain 59.8%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n j code lines	organ system count	n imaging lines	relative claim charge	or	n distinct hcps
1	8.000	11191.000	12.540	9.297	10.461	3.638	0.216	0.958	0.891	0.656
2	13.000	38872.000	13.399	9.825	11.109	3.296	0.332	1.002	0.861	0.681
3	19.000	72660.000	14.462	10.603	11.508	2.795	0.485	1.020	0.835	0.719
4	7.000	17013.000	16.098	11.232	12.054	2.600	0.567	1.051	0.810	0.704

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	1	0	3	2	6
MCC	0	2	0	0	2
No CC/MCC	7	11	16	5	39
All	8	13	19	7	47

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.412	-0.198	0.027
avg_n_j_code_lines	0.390	-0.046	0.028
avg_n_imaging_lines	0.386	-0.038	0.100
avg_relative_claim_charge	0.383	-0.174	-0.267
avg_n_distinct_rev_codes	0.346	-0.129	0.097
avg_n_distinct_hcps	0.166	-0.116	-0.087
rate_dialysis	0.005	0.268	0.137
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_icu	-0.084	0.391	0.423
avg_organ_system_count	-0.196	-0.291	-0.545
rate_transfusion	-0.201	-0.072	0.010
rate_or	-0.386	-0.111	-0.237

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
N83202	Unspecified ovarian cyst, left side	No CC/MCC	3.890	4	502	work rvu (+1.44), relative claim charge (+1.18), or (+0.77)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	3.724	4	1590	n j code lines (+0.82), n imaging lines (+0.63), n distinct rev codes (+0.56)
N83201	Unspecified ovarian cyst, right side	No CC/MCC	3.637	4	664	work rvu (+1.29), relative claim charge (+1.06), or (+0.63)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	2.443	4	1139	n imaging lines (+0.59), n distinct rev codes (+0.42), or (+0.36)
E876	Hypokalemia	No CC/MCC	2.438	4	594	n distinct rev codes (+0.87), n j code lines (+0.82), n imaging lines (+0.69)

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

None.

Top Codes by Tier

Tier 1 (n=8 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K388	Other specified diseases of appendix	No CC/MCC	-2.664	3782	n imaging lines (-0.77), n distinct rev codes (-0.73), n j code lines (-0.52)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	-2.697	638	or (-0.65), relative claim charge (-0.56), organ system count (-0.39)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	-3.029	742	or (-0.68), n j code lines (-0.51), n distinct hcps (-0.46)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	-3.511	582	or (-0.84), transfusion (-0.69), n j code lines (-0.43)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	-3.545	1173	or (-0.90), transfusion (-0.69), work rvu (-0.43)
K36	Other appendicitis	No CC/MCC	-3.700	3127	n distinct rev codes (-0.90), n j code lines (-0.87), n imaging lines (-0.84)
C181	Malignant neoplasm of appendix	CC	-3.756	644	n j code lines (-0.82), n imaging lines (-0.77), n distinct rev codes (-0.61)
D373	Neoplasm of uncertain behavior of appendix	No CC/MCC	-4.508	503	n imaging lines (-0.95), relative claim charge (-0.90), n distinct rev codes (-0.80)

Tier 2 (n=13 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E039	Hypothyroidism, unspecified	No CC/MCC	-0.299	2087	n distinct hcps (-0.15), relative claim charge (-0.14), organ system count (-0.11)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-0.502	5558	relative claim charge (-0.09), n distinct rev codes (-0.07), work rvu (-0.07)
I10	Essential (primary) hypertension	No CC/MCC	-0.512	8994	n distinct hcps (-0.15), or (-0.14), work rvu (-0.13)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	-0.713	1308	or (-0.39), work rvu (-0.19), organ system count (-0.17)
G4730	Sleep apnea, unspecified	No CC/MCC	-0.787	831	work rvu (-0.26), organ system count (-0.26), or (-0.23)
K660	Peritoneal adhesions (postprocedural) (postinfection)	No CC/MCC	-0.814	2619	n distinct rev codes (-0.48), n imaging lines (-0.47), n j code lines (-0.29)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	-0.909	1450	organ system count (-0.30), work rvu (-0.22), n j code lines (-0.15)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-0.921	2462	or (-0.27), n j code lines (-0.24), work rvu (-0.20)
G8929	Other chronic pain	No CC/MCC	-0.932	830	work rvu (+0.43), or (-0.39), n imaging lines (-0.39)
K3533	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess	MCC	-1.032	3143	n j code lines (-0.44), work rvu (-0.35), organ system count (+0.26)

Tier 3 (n=19 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K5900	Constipation, unspecified	No CC/MCC	1.883	792	or (+0.50), relative claim charge (+0.47), work rvu (+0.29)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	1.742	1436	or (+0.41), n imaging lines (+0.39), relative claim charge (+0.23)
K35890	Other acute appendicitis without perforation or gangrene	CC	1.737	3305	or (+0.63), n j code lines (+0.37), organ system count (+0.31)
K35891	Other acute appendicitis without perforation, with gangrene	CC	1.533	1135	n imaging lines (+0.40), n distinct rev codes (+0.38), organ system count (+0.27)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	1.447	550	n distinct rev codes (+0.56), n imaging lines (+0.53), relative claim charge (+0.39)
F909	Attention-deficit hyperactivity disorder, unspecified type	No CC/MCC	1.313	943	or (+0.49), n distinct hcps (+0.20), transfusion (+0.19)
K3580	Unspecified acute appendicitis	CC	1.292	38524	n imaging lines (+0.31), n distinct rev codes (+0.31), organ system count (+0.30)
F32A	Depression, unspecified	No CC/MCC	1.276	1947	relative claim charge (+0.41), n j code lines (+0.37), n imaging lines (+0.19)
F17200	Nicotine dependence, unspecified, uncomplicated	No CC/MCC	0.965	731	n imaging lines (+0.44), n distinct rev codes (+0.28), n j code lines (-0.22)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	0.851	3232	n imaging lines (+0.32), n distinct rev codes (+0.19), n j code lines (+0.12)

Tier 4 (n=7 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N83202	Unspecified ovarian cyst, left side	No CC/MCC	3.890	502	work rvu (+1.44), relative claim charge (+1.18), or (+0.77)
D72829	Elevated white blood cell count, unspecified	No CC/MCC	3.724	1590	n j code lines (+0.82), n imaging lines (+0.63), n distinct rev codes (+0.56)
N83201	Unspecified ovarian cyst, right side	No CC/MCC	3.637	664	work rvu (+1.29), relative claim charge (+1.06), or (+0.63)
K3531	Acute appendicitis with localized peritonitis and gangrene, without perforation	CC	2.574	541	n j code lines (+0.67), or (+0.63), n imaging lines (+0.43)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	2.443	1139	n imaging lines (+0.59), n distinct rev codes (+0.42), or (+0.36)
E876	Hypokalemia	No CC/MCC	2.438	594	n distinct rev codes (+0.87), n j code lines (+0.82), n imaging lines (+0.69)
K3530	Acute appendicitis with localized peritonitis, without perforation or gangrene	CC	2.397	11983	n j code lines (+0.57), n imaging lines (+0.45), or (+0.38)

Key Driver Frequency

feature	count	pct
n j code lines	24	51.100
n imaging lines	23	48.900
or	21	44.700
work rvu	16	34.000
n distinct rev codes	15	31.900
relative claim charge	15	31.900
organ system count	13	27.700
transfusion	8	17.000
n distinct hcps	6	12.800