OP - HE.1.CVC

CM Codes

Data Overview

7173 total codes in komodo_rii; 207 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	119
CC	87
MCC	1

PCA Analysis

PC1 explains 23.6% of variance; PC1+PC2 together explain 42.8%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	organ system count	n j code lines	work rvu	n distinct rev codes	or	relative claim charge	n distinct hcps	n imaging lines
1	100.000	266190.000	2.200	5.063	7.264	8.310	0.792	1.010	0.745	0.023
2	53.000	214819.000	3.408	5.499	7.293	8.446	0.831	1.049	0.728	0.017
3	54.000	177790.000	4.433	5.912	6.992	8.531	0.868	1.052	0.732	0.012

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	65	17	5	87
MCC	0	0	1	1
No CC/MCC	35	36	48	119
All	100	53	54	207

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_organ_system_count	0.529	-0.070	-0.405
rate_or	0.504	0.060	-0.371
avg_n_j_code_lines	0.462	0.061	-0.545
avg_relative_claim_charge	0.242	-0.212	-0.154
avg_n_distinct_rev_codes	0.227	-0.173	-0.034
rate_dialysis	0.190	0.119	-0.194
rate_mechanical_ventilation	0.122	0.124	-0.104
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_transfusion	-0.016	-0.068	-0.159
rate_icu	-0.075	0.170	0.085
avg_n_distinct_hcps	-0.123	0.026	-0.061
avg_work_rvu	-0.130	-0.279	0.379
avg_n_imaging_lines	-0.233	-0.014	0.427

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
D631	Anemia in chronic kidney disease	No CC/MCC	3.756	3	994	dialysis (+1.03), or (+0.81), organ system count (+0.78)
I872	Venous insufficiency (chronic) (peripheral)	No CC/MCC	3.397	3	4142	or (+1.29), n j code lines (+1.15), relative claim charge (+0.25)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	3.393	3	741	n j code lines (+1.14), or (+1.12), organ system count (+0.86)
I509	Heart failure, unspecified	No CC/MCC	3.309	3	3656	mechanical ventilation (+1.11), or (+0.83), organ system count (+0.53)
I110	Hypertensive heart disease with heart failure	No CC/MCC	3.226	3	3600	mechanical ventilation (+1.13), or (+0.82), organ system count (+0.46)

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

None.

Top Codes by Tier

Tier 1 (n=100 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C3412	Malignant neoplasm of upper lobe, left bronchus or lung	CC	-0.618	4545	icu (-0.39), n j code lines (-0.31), or (+0.26)
C029	Malignant neoplasm of tongue, unspecified	No CC/MCC	-0.618	757	organ system count (-0.44), n distinct hcps (+0.18), n j code lines (-0.16)
C250	Malignant neoplasm of head of pancreas	CC	-0.625	4491	organ system count (-0.36), n imaging lines (-0.11), or (-0.08)
D500	Iron deficiency anemia secondary to blood loss (chronic)	No CC/MCC	-0.634	1025	n j code lines (-0.50), organ system count (-0.22), relative claim charge (-0.14)
C210	Malignant neoplasm of anus, unspecified	CC	-0.640	2150	organ system count (-0.41), n distinct rev codes (-0.22), relative claim charge (-0.12)
C3431	Malignant neoplasm of lower lobe, right bronchus or lung	CC	-0.666	2881	n j code lines (-0.27), relative claim charge (-0.26), organ system count (-0.24)
J90	Pleural effusion, not elsewhere classified	CC	-0.670	1379	n imaging lines (-0.65), relative claim charge (+0.46), or (-0.33)
G90A	Postural orthostatic tachycardia syndrome [POTS]	No CC/MCC	-0.670	775	or (-1.08), n j code lines (+0.61), n distinct rev codes (-0.32)
C3490	Malignant neoplasm of unspecified part of unspecified bronchus or lung	CC	-0.715	12033	n j code lines (-0.46), organ system count (-0.35), relative claim charge (-0.23)
C50311	Malignant neoplasm of lower-inner quadrant of right female breast	No CC/MCC	-0.744	786	organ system count (-0.51), n j code lines (+0.38), or (-0.27)

Tier 2 (n=53 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J45909	Unspecified asthma, uncomplicated	No CC/MCC	1.347	6796	n j code lines (+0.71), organ system count (+0.60), n distinct rev codes (-0.27)
F411	Generalized anxiety disorder	No CC/MCC	1.322	624	organ system count (+0.72), n j code lines (+0.33), or (+0.28)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	1.306	2279	organ system count (+0.81), or (+0.46), n distinct hcps (-0.12)
M549	Dorsalgia, unspecified	No CC/MCC	1.248	649	organ system count (+1.02), n j code lines (+0.33), n distinct hcps (-0.15)
N184	Chronic kidney disease, stage 4 (severe)	CC	1.245	647	organ system count (+0.64), or (+0.30), n imaging lines (+0.24)
M810	Age-related osteoporosis without current pathological fracture	No CC/MCC	1.194	1961	organ system count (+0.72), or (+0.41), n imaging lines (+0.14)
T82514A	Breakdown (mechanical) of infusion catheter, initial encounter	CC	1.187	771	relative claim charge (+0.99), work rvu (-0.74), n distinct hcps (+0.26)
M329	Systemic lupus erythematosus, unspecified	No CC/MCC	1.171	643	n j code lines (+0.69), organ system count (+0.30), n imaging lines (+0.19)
G629	Polyneuropathy, unspecified	No CC/MCC	1.150	1419	organ system count (+0.69), n j code lines (+0.39), n imaging lines (+0.18)
F1290	Cannabis use, unspecified, uncomplicated	No CC/MCC	1.144	599	n j code lines (+0.56), or (+0.43), organ system count (+0.36)

Tier 3 (n=54 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	4.307	780	dialysis (+1.80), organ system count (+0.59), n distinct rev codes (+0.58)
D631	Anemia in chronic kidney disease	No CC/MCC	3.756	994	dialysis (+1.03), or (+0.81), organ system count (+0.78)
I872	Venous insufficiency (chronic) (peripheral)	No CC/MCC	3.397	4142	or (+1.29), n j code lines (+1.15), relative claim charge (+0.25)
J4489	Other specified chronic obstructive pulmonary disease	No CC/MCC	3.393	741	n j code lines (+1.14), or (+1.12), organ system count (+0.86)
I509	Heart failure, unspecified	No CC/MCC	3.309	3656	mechanical ventilation (+1.11), or (+0.83), organ system count (+0.53)
I110	Hypertensive heart disease with heart failure	No CC/MCC	3.226	3600	mechanical ventilation (+1.13), or (+0.82), organ system count (+0.46)
N186	End stage renal disease	MCC	3.217	1339	dialysis (+1.66), or (+0.45), n distinct rev codes (+0.43)
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	3.124	1348	or (+1.03), organ system count (+0.88), n j code lines (+0.49)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	3.080	924	or (+1.01), organ system count (+0.71), n j code lines (+0.44)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	2.834	864	n j code lines (+1.22), or (+0.77), organ system count (+0.73)

Key Driver Frequency

feature	count	pct
organ system count	184	88.900
or	143	69.100
n j code lines	135	65.200
relative claim charge	47	22.700
n distinct rev codes	45	21.700
n imaging lines	30	14.500
n distinct hcps	19	9.200
work rvu	8	3.900
dialysis	4	1.900
icu	3	1.400
mechanical ventilation	3	1.400