OP - GA.0.cholecystectomy

CM Codes

Data Overview

5951 total codes in komodo_rii; 134 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	116
CC	15
MCC	3

PCA Analysis

PC1 explains 30.8% of variance; PC1+PC2 together explain 49.6%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	work rvu	n j code lines	organ system count	n imaging lines	relative claim charge	n distinct hcps	or
1	92.000	832200.000	8.197	11.866	10.313	3.726	0.022	1.010	0.700	0.889
2	36.000	88184.000	8.589	12.825	10.437	3.319	0.045	1.074	0.670	0.886
3	6.000	17909.000	10.608	14.144	11.426	3.094	0.236	1.183	0.571	0.868

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	6	7	2	15
MCC	1	2	0	3
No CC/MCC	85	27	4	116
All	92	36	6	134

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_imaging_lines	0.465	-0.074	-0.008
avg_n_distinct_rev_codes	0.449	-0.076	0.091
avg_relative_claim_charge	0.424	-0.181	0.250
avg_work_rvu	0.411	-0.056	0.160
avg_n_j_code_lines	0.267	0.085	0.011
rate_icu	0.207	0.346	0.144
rate_transfusion	0.061	0.157	0.068
rate_dialysis	0.060	0.195	0.129
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_mechanical_ventilation	-0.052	0.269	-0.069
rate_or	-0.078	-0.084	-0.198
avg_organ_system_count	-0.116	-0.214	-0.339
avg_n_distinct_hcps	-0.300	-0.033	-0.302

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
D72829	Elevated white blood cell count, unspecified	No CC/MCC	10.852	3	724	n imaging lines (+2.63), n distinct rev codes (+2.54), work rvu (+1.66)
E876	Hypokalemia	No CC/MCC	6.832	3	897	n imaging lines (+1.73), n distinct rev codes (+1.72), n distinct hcps (+1.25)
K82A1	Gangrene of gallbladder in cholecystitis	No CC/MCC	6.787	3	1472	n imaging lines (+1.68), n distinct rev codes (+1.36), relative claim charge (+1.33)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	6.170	3	815	n imaging lines (+2.00), relative claim charge (+1.91), n distinct rev codes (+1.03)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K8510	Biliary acute pancreatitis without necrosis or infection	MCC	0.017	1	3545	icu (+0.19), n imaging lines (-0.18), n distinct rev codes (-0.17)

Top Codes by Tier

Tier 1 (n=92 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I110	Hypertensive heart disease with heart failure	No CC/MCC	0.069	2804	n distinct hcps (+0.37), relative claim charge (+0.23), n imaging lines (-0.18)
K8510	Biliary acute pancreatitis without necrosis or infection	MCC	0.017	3545	icu (+0.19), n imaging lines (-0.18), n distinct rev codes (-0.17)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	-0.031	3703	n distinct rev codes (+0.43), n distinct hcps (+0.33), n j code lines (-0.28)
E66812	Obesity, class 2	No CC/MCC	-0.144	780	n j code lines (+0.77), n distinct rev codes (-0.54), relative claim charge (+0.48)
I480	Paroxysmal atrial fibrillation	No CC/MCC	-0.153	1903	n distinct hcps (+0.37), work rvu (-0.18), n j code lines (-0.17)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	-0.218	764	n distinct hcps (+0.26), work rvu (-0.25), n imaging lines (-0.22)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	-0.252	1985	n j code lines (-0.30), n distinct rev codes (+0.22), n imaging lines (+0.20)
K660	Peritoneal adhesions (postprocedural) (postinfection)	No CC/MCC	-0.269	17472	n distinct rev codes (-0.37), n imaging lines (-0.20), relative claim charge (+0.20)
D649	Anemia, unspecified	No CC/MCC	-0.295	4614	n distinct hcps (-0.15), icu (+0.15), relative claim charge (-0.11)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	-0.297	678	n distinct rev codes (+0.30), n imaging lines (-0.28), n distinct hcps (+0.28)

Tier 2 (n=36 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K8066	Calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction	CC	2.594	908	n distinct rev codes (+0.60), relative claim charge (+0.53), work rvu (+0.49)
K8012	Calculus of gallbladder with acute and chronic cholecystitis without obstruction	CC	2.545	24965	n imaging lines (+0.68), n distinct rev codes (+0.64), relative claim charge (+0.37)
K439	Ventral hernia without obstruction or gangrene	No CC/MCC	2.450	868	work rvu (+1.39), relative claim charge (+0.98), organ system count (+0.11)
K821	Hydrops of gallbladder	CC	2.417	2228	relative claim charge (+0.70), n imaging lines (+0.54), n distinct hcps (+0.35)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	2.358	1360	icu (+0.64), n distinct rev codes (+0.59), n distinct hcps (+0.50)
N200	Calculus of kidney	No CC/MCC	2.329	709	n imaging lines (+1.25), n distinct rev codes (+0.47), work rvu (+0.37)
K4090	Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent	No CC/MCC	2.273	593	work rvu (+1.32), relative claim charge (+0.53), n distinct hcps (+0.20)
K432	Incisional hernia without obstruction or gangrene	No CC/MCC	1.894	829	work rvu (+1.50), relative claim charge (+0.81), n imaging lines (-0.24)
K7689	Other specified diseases of liver	No CC/MCC	1.499	1386	relative claim charge (+0.81), work rvu (+0.51), organ system count (+0.14)
K838	Other specified diseases of biliary tract	No CC/MCC	1.412	2233	n j code lines (+0.35), n distinct rev codes (+0.31), work rvu (+0.28)

Tier 3 (n=6 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D72829	Elevated white blood cell count, unspecified	No CC/MCC	10.852	724	n imaging lines (+2.63), n distinct rev codes (+2.54), work rvu (+1.66)
E876	Hypokalemia	No CC/MCC	6.832	897	n imaging lines (+1.73), n distinct rev codes (+1.72), n distinct hcps (+1.25)
K82A1	Gangrene of gallbladder in cholecystitis	No CC/MCC	6.787	1472	n imaging lines (+1.68), n distinct rev codes (+1.36), relative claim charge (+1.33)
K810	Acute cholecystitis	CC	6.748	5155	n imaging lines (+1.78), n distinct rev codes (+1.69), relative claim charge (+1.05)
K8000	Calculus of gallbladder with acute cholecystitis without obstruction	CC	6.241	8846	n imaging lines (+1.59), n distinct rev codes (+1.40), relative claim charge (+0.98)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	6.170	815	n imaging lines (+2.00), relative claim charge (+1.91), n distinct rev codes (+1.03)

Key Driver Frequency

feature	count	pct
relative claim charge	89	66.400
n distinct rev codes	71	53.000
work rvu	68	50.700
n distinct hcps	60	44.800
n imaging lines	50	37.300
n j code lines	44	32.800
organ system count	9	6.700
icu	8	6.000
mechanical ventilation	1	0.700
transfusion	1	0.700
dialysis	1	0.700