OP - HE.1.bone_marrow_biopsy

CM Codes

Data Overview

7113 total codes in komodo_rii; 134 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	90
CC	42
MCC	2

PCA Analysis

PC1 explains 32.1% of variance; PC1+PC2 together explain 56.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	n j code lines	n imaging lines	work rvu	organ system count	or	relative claim charge	transfusion
1	99.000	322462.000	7.688	1.943	0.493	5.640	2.887	0.641	1.021	0.019
2	22.000	64370.000	8.119	2.023	0.263	5.349	2.739	0.529	1.063	0.059
3	13.000	15440.000	8.873	2.543	0.172	5.383	3.004	0.550	1.138	0.107

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	26	11	5	42
MCC	1	0	1	2
No CC/MCC	72	11	7	90
All	99	22	13	134

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
rate_transfusion	0.423	0.004	0.117
avg_n_distinct_rev_codes	0.357	-0.044	-0.112
avg_relative_claim_charge	0.343	-0.168	0.019
rate_dialysis	0.337	0.277	0.150
rate_icu	0.327	0.089	0.016
avg_n_distinct_hcps	0.278	-0.016	0.144
avg_n_j_code_lines	0.245	0.006	-0.278
avg_organ_system_count	0.056	-0.068	-0.423
avg_length_of_stay	0.000	nan	nan
rate_mechanical_ventilation	0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_work_rvu	-0.121	-0.057	-0.085
rate_or	-0.276	0.009	-0.381
avg_n_imaging_lines	-0.351	0.116	-0.362

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
E876	Hypokalemia	No CC/MCC	5.153	3	818	dialysis (+1.30), transfusion (+1.21), icu (+0.91)
D84821	Immunodeficiency due to drugs	No CC/MCC	4.753	3	1613	icu (+1.41), n j code lines (+0.96), n distinct rev codes (+0.78)
E8342	Hypomagnesemia	No CC/MCC	4.612	3	1634	icu (+0.84), n distinct rev codes (+0.76), n imaging lines (+0.67)
K5900	Constipation, unspecified	No CC/MCC	4.345	3	564	icu (+1.37), n distinct rev codes (+0.57), n imaging lines (+0.48)
D6481	Anemia due to antineoplastic chemotherapy	No CC/MCC	3.910	3	757	relative claim charge (+1.35), icu (+0.89), transfusion (+0.81)

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	-1.330	1	800	relative claim charge (-0.36), or (-0.31), n distinct hcps (-0.29)

Top Codes by Tier

Tier 1 (n=99 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D72818	Other decreased white blood cell count	No CC/MCC	0.326	574	relative claim charge (+0.54), or (-0.47), dialysis (+0.39)
I4891	Unspecified atrial fibrillation	No CC/MCC	0.291	2652	n distinct rev codes (+0.23), n distinct hcps (+0.19), n imaging lines (-0.15)
D849	Immunodeficiency, unspecified	CC	0.275	3310	n imaging lines (-1.06), relative claim charge (+0.56), icu (+0.41)
D61818	Other pancytopenia	CC	0.200	13855	transfusion (+0.45), n distinct rev codes (-0.16), n distinct hcps (-0.12)
E785	Hyperlipidemia, unspecified	No CC/MCC	0.030	10537	n distinct rev codes (+0.22), n imaging lines (-0.15), n j code lines (+0.14)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	0.027	756	dialysis (-0.25), n distinct hcps (+0.21), icu (-0.12)
M109	Gout, unspecified	No CC/MCC	-0.065	706	n distinct rev codes (+0.26), dialysis (-0.25), relative claim charge (+0.20)
G629	Polyneuropathy, unspecified	No CC/MCC	-0.072	1964	n distinct hcps (+0.41), n distinct rev codes (+0.29), dialysis (-0.25)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	-0.082	2684	n j code lines (+0.25), transfusion (-0.25), n distinct hcps (+0.23)
C9210	Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission	CC	-0.100	2489	dialysis (+0.59), relative claim charge (-0.49), n distinct rev codes (-0.36)

Tier 2 (n=22 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C9310	Chronic myelomonocytic leukemia not having achieved remission	CC	2.993	1825	dialysis (+1.47), or (+0.58), transfusion (+0.53)
C9102	Acute lymphoblastic leukemia, in relapse	CC	2.757	1170	n j code lines (+0.83), n imaging lines (+0.72), transfusion (+0.61)
D89813	Graft-versus-host disease, unspecified	CC	2.580	753	relative claim charge (+0.71), n imaging lines (+0.65), or (+0.42)
G4700	Insomnia, unspecified	No CC/MCC	2.488	672	icu (+1.20), n distinct rev codes (+0.51), relative claim charge (+0.30)
C9200	Acute myeloblastic leukemia, not having achieved remission	CC	2.448	13752	transfusion (+0.93), dialysis (+0.86), n imaging lines (+0.53)
C9101	Acute lymphoblastic leukemia, in remission	CC	2.154	3109	n imaging lines (+0.69), icu (+0.57), n distinct hcps (+0.46)
N179	Acute kidney failure, unspecified	CC	2.133	786	icu (+0.94), n distinct rev codes (+0.49), transfusion (+0.35)
C9100	Acute lymphoblastic leukemia not having achieved remission	CC	2.024	6714	n imaging lines (+0.64), relative claim charge (-0.53), dialysis (+0.44)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	1.970	1416	relative claim charge (+0.96), icu (+0.51), n distinct rev codes (+0.25)
C9201	Acute myeloblastic leukemia, in remission	CC	1.956	5761	n imaging lines (+0.64), dialysis (+0.53), transfusion (+0.39)

Tier 3 (n=13 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D61810	Antineoplastic chemotherapy induced pancytopenia	MCC	5.878	1155	transfusion (+1.79), relative claim charge (+0.95), dialysis (+0.79)
T865	Complications of stem cell transplant	CC	5.209	877	n distinct rev codes (+1.21), n distinct hcps (+1.04), relative claim charge (+0.86)
E876	Hypokalemia	No CC/MCC	5.153	818	dialysis (+1.30), transfusion (+1.21), icu (+0.91)
D84821	Immunodeficiency due to drugs	No CC/MCC	4.753	1613	icu (+1.41), n j code lines (+0.96), n distinct rev codes (+0.78)
E8342	Hypomagnesemia	No CC/MCC	4.612	1634	icu (+0.84), n distinct rev codes (+0.76), n imaging lines (+0.67)
D89811	Chronic graft-versus-host disease	CC	4.527	515	n distinct rev codes (+1.21), relative claim charge (+0.96), n distinct hcps (+0.78)
C9202	Acute myeloblastic leukemia, in relapse	CC	4.454	1999	transfusion (+2.43), dialysis (+0.66), n imaging lines (+0.64)
K5900	Constipation, unspecified	No CC/MCC	4.345	564	icu (+1.37), n distinct rev codes (+0.57), n imaging lines (+0.48)
D6481	Anemia due to antineoplastic chemotherapy	No CC/MCC	3.910	757	relative claim charge (+1.35), icu (+0.89), transfusion (+0.81)
T451X5A	Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter	No CC/MCC	3.840	2234	transfusion (+0.78), n distinct rev codes (+0.62), n j code lines (+0.55)

Key Driver Frequency

feature	count	pct
n distinct rev codes	79	59.000
n imaging lines	52	38.800
n distinct hcps	50	37.300
transfusion	48	35.800
or	46	34.300
relative claim charge	44	32.800
dialysis	38	28.400
n j code lines	26	19.400
icu	16	11.900
work rvu	3	2.200