OP - GA.0.hernia_repair
CM Codes
Data Overview
6795 total codes in komodo_rii; 155 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 135 |
| CC | 19 |
| MCC | 1 |
PCA Analysis
PC1 explains 25.6% of variance; PC1+PC2 together explain 42.4%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | work rvu | organ system count | n distinct rev codes | n j code lines | or | n distinct hcps | relative claim charge | transfusion |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 117.000 | 575503.000 | 8.782 | 4.200 | 7.753 | 9.128 | 0.916 | 0.740 | 1.018 | 0.002 |
| 2 | 32.000 | 499654.000 | 10.017 | 2.969 | 7.275 | 9.303 | 0.866 | 0.718 | 1.081 | 0.001 |
| 3 | 6.000 | 7667.000 | 14.831 | 2.083 | 6.327 | 8.242 | 0.792 | 0.657 | 1.076 | 0.001 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 10 | 6 | 3 | 19 |
| MCC | 1 | 0 | 0 | 1 |
| No CC/MCC | 106 | 26 | 3 | 135 |
| All | 117 | 32 | 6 | 155 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_work_rvu | 0.420 | -0.068 | 0.318 |
| rate_icu | 0.312 | 0.267 | 0.154 |
| avg_relative_claim_charge | 0.204 | 0.084 | 0.073 |
| avg_n_imaging_lines | 0.014 | -0.015 | 0.136 |
| avg_length_of_stay | -0.000 | nan | nan |
| rate_multiple_or_days | -0.000 | nan | nan |
| rate_mechanical_ventilation | -0.020 | 0.160 | 0.057 |
| avg_n_j_code_lines | -0.044 | 0.196 | -0.136 |
| rate_transfusion | -0.077 | 0.122 | 0.085 |
| rate_dialysis | -0.101 | 0.380 | 0.105 |
| avg_n_distinct_hcps | -0.217 | -0.238 | -0.296 |
| avg_n_distinct_rev_codes | -0.398 | -0.096 | 0.156 |
| rate_or | -0.474 | -0.225 | 0.002 |
| avg_organ_system_count | -0.485 | -0.165 | -0.108 |
Top 6 Tier-Discriminating Features
Bottom 6 Tier-Discriminating Features
Score Validation
Misclassification Audit (N=10 samples)
Over-tiered: Tier 3, No CC/MCC (3 codes)
| code | code_description | cms_severity | intensity_score | tier | n_claims | key_drivers |
|---|---|---|---|---|---|---|
| Q5310 | Unspecified undescended testicle, unilateral | No CC/MCC | 5.900 | 3 | 1442 | work rvu (+2.46), n distinct rev codes (+1.69), organ system count (+1.58) |
| Q53112 | Unilateral inguinal testis | No CC/MCC | 5.100 | 3 | 1372 | work rvu (+2.24), n distinct rev codes (+1.64), organ system count (+1.61) |
| N471 | Phimosis | No CC/MCC | 5.047 | 3 | 656 | work rvu (+1.48), n distinct rev codes (+1.29), organ system count (+0.99) |
Under-tiered: Tier 1, MCC (1 codes)
| code | code_description | cms_severity | intensity_score | tier | n_claims | key_drivers |
|---|---|---|---|---|---|---|
| N186 | End stage renal disease | MCC | -2.088 | 1 | 1504 | n distinct rev codes (-0.92), dialysis (-0.85), organ system count (-0.39) |
Top Codes by Tier
Tier 1 (n=117 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| F17210 | Nicotine dependence, cigarettes, uncomplicated | No CC/MCC | 0.412 | 24153 | or (+0.23), organ system count (+0.22), work rvu (-0.20) |
| K219 | Gastro-esophageal reflux disease without esophagitis | No CC/MCC | 0.298 | 50032 | organ system count (+0.25), or (+0.18), work rvu (-0.14) |
| E669 | Obesity, unspecified | No CC/MCC | 0.256 | 21034 | or (+0.29), n distinct rev codes (+0.21), work rvu (-0.19) |
| J4520 | Mild intermittent asthma, uncomplicated | No CC/MCC | 0.240 | 1735 | n distinct rev codes (+0.49), or (+0.35), n distinct hcps (-0.28) |
| D1779 | Benign lipomatous neoplasm of other sites | No CC/MCC | 0.235 | 1983 | organ system count (+0.26), n distinct hcps (-0.24), relative claim charge (+0.15) |
| F17200 | Nicotine dependence, unspecified, uncomplicated | No CC/MCC | 0.229 | 4025 | organ system count (+0.30), work rvu (-0.20), n distinct hcps (+0.09) |
| F17220 | Nicotine dependence, chewing tobacco, uncomplicated | No CC/MCC | 0.221 | 1504 | work rvu (-0.28), organ system count (+0.24), or (+0.22) |
| J4540 | Moderate persistent asthma, uncomplicated | No CC/MCC | 0.196 | 516 | n distinct rev codes (+0.48), or (+0.28), work rvu (-0.21) |
| I10 | Essential (primary) hypertension | No CC/MCC | 0.157 | 99930 | or (+0.16), organ system count (+0.16), work rvu (-0.14) |
| K5730 | Diverticulosis of large intestine without perforation or abscess without bleeding | No CC/MCC | 0.127 | 933 | n distinct rev codes (-0.21), organ system count (+0.19), relative claim charge (+0.19) |
Tier 2 (n=32 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| N432 | Other hydrocele | No CC/MCC | 3.467 | 974 | n distinct rev codes (+1.49), work rvu (+1.11), organ system count (+1.05) |
| K4000 | Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent | CC | 2.897 | 2883 | icu (+1.00), organ system count (+0.74), relative claim charge (+0.71) |
| N433 | Hydrocele, unspecified | No CC/MCC | 2.858 | 3416 | work rvu (+1.23), n distinct rev codes (+0.76), organ system count (+0.62) |
| D171 | Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk | No CC/MCC | 2.750 | 1566 | icu (+1.10), work rvu (+0.87), or (+0.48) |
| K4021 | Bilateral inguinal hernia, without obstruction or gangrene, recurrent | No CC/MCC | 2.615 | 3028 | work rvu (+0.83), organ system count (+0.77), relative claim charge (+0.72) |
| K4020 | Bilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent | No CC/MCC | 2.335 | 58136 | organ system count (+0.86), relative claim charge (+0.56), or (+0.42) |
| M6208 | Separation of muscle (nontraumatic), other site | No CC/MCC | 2.237 | 1522 | or (+1.39), n distinct rev codes (+0.38), organ system count (+0.27) |
| K4031 | Unilateral inguinal hernia, with obstruction, without gangrene, recurrent | CC | 2.107 | 2183 | organ system count (+0.71), work rvu (+0.63), relative claim charge (+0.55) |
| K429 | Umbilical hernia without obstruction or gangrene | No CC/MCC | 2.057 | 68133 | organ system count (+1.03), or (+0.74), n distinct rev codes (+0.71) |
| K4091 | Unilateral inguinal hernia, without obstruction or gangrene, recurrent | No CC/MCC | 2.009 | 22417 | organ system count (+0.77), work rvu (+0.74), n distinct hcps (+0.25) |
Tier 3 (n=6 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| K430 | Incisional hernia with obstruction, without gangrene | CC | 8.515 | 538 | icu (+3.03), or (+1.60), work rvu (+1.55) |
| K436 | Other and unspecified ventral hernia with obstruction, without gangrene | CC | 7.757 | 981 | or (+2.48), icu (+1.70), organ system count (+0.99) |
| Q5310 | Unspecified undescended testicle, unilateral | No CC/MCC | 5.900 | 1442 | work rvu (+2.46), n distinct rev codes (+1.69), organ system count (+1.58) |
| K420 | Umbilical hernia with obstruction, without gangrene | CC | 5.519 | 2678 | or (+2.47), organ system count (+0.94), n distinct hcps (+0.85) |
| Q53112 | Unilateral inguinal testis | No CC/MCC | 5.100 | 1372 | work rvu (+2.24), n distinct rev codes (+1.64), organ system count (+1.61) |
| N471 | Phimosis | No CC/MCC | 5.047 | 656 | work rvu (+1.48), n distinct rev codes (+1.29), organ system count (+0.99) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| organ system count | 113 | 72.900 |
| or | 111 | 71.600 |
| n distinct rev codes | 80 | 51.600 |
| work rvu | 71 | 45.800 |
| n distinct hcps | 52 | 33.500 |
| relative claim charge | 24 | 15.500 |
| icu | 8 | 5.200 |
| dialysis | 3 | 1.900 |
| transfusion | 2 | 1.300 |
| mechanical ventilation | 1 | 0.600 |
