OP - LA.0.urinalysis

CM Codes

Data Overview

28349 total codes in komodo_rii; 236 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	201
CC	32
MCC	3

PCA Analysis

PC1 explains 35.9% of variance; PC1+PC2 together explain 57.5%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	n distinct rev codes	n distinct hcps	organ system count	relative claim charge	n imaging lines	or
1	15.000	490835.000	4.443	1.819	1.618	0.174	2.088	1.387	0.014	0.003
2	36.000	1208736.000	2.728	0.979	1.942	0.336	2.116	1.272	0.008	0.002
3	74.000	3718477.000	1.284	0.412	2.273	0.531	2.192	1.129	0.003	0.001
4	111.000	8661681.000	0.400	0.100	2.809	0.686	2.395	1.282	0.001	0.000

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	3	5	12	12	32
MCC	1	1	0	1	3
No CC/MCC	11	30	62	98	201
All	15	36	74	111	236

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_hcps	0.447	0.135	-0.049
avg_n_distinct_rev_codes	0.343	0.111	-0.035
avg_organ_system_count	0.088	0.087	-0.165
rate_dialysis	0.056	0.229	0.151
avg_relative_claim_charge	0.026	-0.027	0.041
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_mechanical_ventilation	-0.126	0.248	0.110
rate_icu	-0.145	0.071	0.137
rate_transfusion	-0.168	-0.011	0.172
rate_or	-0.233	-0.091	-0.115
avg_n_imaging_lines	-0.373	-0.005	0.038
avg_n_j_code_lines	-0.444	-0.113	0.011
avg_work_rvu	-0.464	-0.164	-0.017

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
E790	Hyperuricemia without signs of inflammatory arthritis and tophaceous disease	No CC/MCC	2.562	4	28970	n distinct rev codes (+0.54), n distinct hcps (+0.53), work rvu (+0.46)
D519	Vitamin B12 deficiency anemia, unspecified	No CC/MCC	2.559	4	18272	n distinct hcps (+0.58), work rvu (+0.47), n distinct rev codes (+0.43)
E839	Disorder of mineral metabolism, unspecified	No CC/MCC	2.531	4	11347	n distinct hcps (+0.56), work rvu (+0.45), n j code lines (+0.38)
I519	Heart disease, unspecified	No CC/MCC	2.423	4	12690	n distinct rev codes (+0.49), work rvu (+0.46), n distinct hcps (+0.45)
E538	Deficiency of other specified B group vitamins	No CC/MCC	2.306	4	121174	n distinct hcps (+0.49), work rvu (+0.45), n distinct rev codes (+0.40)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J189	Pneumonia, unspecified organism	MCC	-5.700	1	14066	n imaging lines (-1.30), n distinct hcps (-0.95), work rvu (-0.89)

Top Codes by Tier

Tier 1 (n=15 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K529	Noninfective gastroenteritis and colitis, unspecified	No CC/MCC	-3.944	58780	n j code lines (-0.92), work rvu (-0.91), n distinct hcps (-0.89)
E860	Dehydration	No CC/MCC	-4.007	59613	n distinct hcps (-1.03), n j code lines (-0.94), work rvu (-0.80)
N12	Tubulo-interstitial nephritis, not specified as acute or chronic	CC	-4.017	22448	n imaging lines (-1.35), n j code lines (-0.94), n distinct hcps (-0.66)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	-4.147	34805	n distinct hcps (-1.02), work rvu (-0.97), n j code lines (-0.87)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	-4.575	13587	n j code lines (-1.15), work rvu (-1.14), n distinct hcps (-0.91)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	-4.708	16536	work rvu (-1.27), n distinct hcps (-1.09), n j code lines (-1.09)
K8020	Calculus of gallbladder without cholecystitis without obstruction	No CC/MCC	-5.342	20473	n j code lines (-1.33), work rvu (-1.27), n distinct hcps (-1.02)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-5.408	110332	n imaging lines (-1.71), work rvu (-0.94), n distinct hcps (-0.91)
N920	Excessive and frequent menstruation with regular cycle	No CC/MCC	-5.597	24447	or (-2.07), n j code lines (-1.39), transfusion (-1.35)
K5732	Diverticulitis of large intestine without perforation or abscess without bleeding	CC	-5.655	14321	n imaging lines (-1.46), work rvu (-1.41), n distinct hcps (-1.21)

Tier 2 (n=36 codes)

code	Description	CMS severity	Score	N claims	Key drivers
O219	Vomiting of pregnancy, unspecified	No CC/MCC	-1.381	29324	n distinct hcps (-0.54), n distinct rev codes (-0.39), n j code lines (-0.37)
F419	Anxiety disorder, unspecified	No CC/MCC	-1.481	145761	n j code lines (-0.34), work rvu (-0.28), or (-0.28)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	-1.621	50969	n imaging lines (-0.51), work rvu (-0.39), n j code lines (-0.39)
M549	Dorsalgia, unspecified	No CC/MCC	-1.764	63185	n imaging lines (-0.61), n distinct hcps (-0.36), n distinct rev codes (-0.34)
F32A	Depression, unspecified	No CC/MCC	-1.819	80138	n j code lines (-0.41), work rvu (-0.38), or (-0.33)
E282	Polycystic ovarian syndrome	No CC/MCC	-2.011	18679	or (-0.61), n j code lines (-0.56), work rvu (-0.43)
K589	Irritable bowel syndrome, unspecified	No CC/MCC	-2.018	11385	n j code lines (-0.61), work rvu (-0.50), n distinct hcps (-0.37)
J101	Influenza due to other identified influenza virus with other respiratory manifestations	No CC/MCC	-2.057	13774	n distinct hcps (-0.87), work rvu (-0.54), n distinct rev codes (-0.45)
E8720	Acidosis, unspecified	No CC/MCC	-2.222	18660	mechanical ventilation (-1.25), icu (-1.20), n imaging lines (-0.36)
K625	Hemorrhage of anus and rectum	CC	-2.230	13931	n imaging lines (-0.61), n distinct hcps (-0.54), work rvu (-0.51)

Tier 3 (n=74 codes)

code	Description	CMS severity	Score	N claims	Key drivers
O09522	Supervision of elderly multigravida, second trimester	No CC/MCC	0.691	12595	n j code lines (+0.29), n imaging lines (+0.27), n distinct hcps (+0.23)
I5022	Chronic systolic (congestive) heart failure	CC	0.664	13258	icu (-0.41), n distinct rev codes (+0.34), work rvu (+0.28)
E8342	Hypomagnesemia	No CC/MCC	0.661	59713	n distinct rev codes (+0.46), icu (-0.25), work rvu (+0.22)
N898	Other specified noninflammatory disorders of vagina	No CC/MCC	0.661	138196	n j code lines (+0.28), n imaging lines (+0.24), n distinct rev codes (-0.19)
M25562	Pain in left knee	No CC/MCC	0.628	19290	n j code lines (+0.21), n imaging lines (-0.14), work rvu (+0.10)
C189	Malignant neoplasm of colon, unspecified	CC	0.613	11356	work rvu (+0.34), n j code lines (-0.15), n distinct hcps (+0.15)
D649	Anemia, unspecified	No CC/MCC	0.609	217320	transfusion (-0.58), n distinct rev codes (+0.31), n distinct hcps (+0.22)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	0.608	33583	n distinct rev codes (+0.29), organ system count (+0.11), n distinct hcps (+0.11)
O99212	Obesity complicating pregnancy, second trimester	No CC/MCC	0.602	11191	n j code lines (+0.29), n imaging lines (+0.26), n distinct hcps (+0.25)
J4520	Mild intermittent asthma, uncomplicated	No CC/MCC	0.585	19787	n distinct rev codes (+0.21), n imaging lines (+0.17), n distinct hcps (+0.15)

Tier 4 (n=111 codes)

code	Description	CMS severity	Score	N claims	Key drivers
T8610	Unspecified complication of kidney transplant	CC	3.194	25774	n distinct rev codes (+0.92), n distinct hcps (+0.84), work rvu (+0.47)
B20	Human immunodeficiency virus [HIV] disease	CC	2.871	41056	n distinct rev codes (+1.01), n distinct hcps (+0.62), work rvu (+0.34)
T8619	Other complication of kidney transplant	CC	2.801	11659	n distinct rev codes (+0.64), n distinct hcps (+0.63), work rvu (+0.43)
B259	Cytomegaloviral disease, unspecified	CC	2.728	12993	n distinct rev codes (+0.85), n distinct hcps (+0.49), work rvu (+0.45)
E790	Hyperuricemia without signs of inflammatory arthritis and tophaceous disease	No CC/MCC	2.562	28970	n distinct rev codes (+0.54), n distinct hcps (+0.53), work rvu (+0.46)
D519	Vitamin B12 deficiency anemia, unspecified	No CC/MCC	2.559	18272	n distinct hcps (+0.58), work rvu (+0.47), n distinct rev codes (+0.43)
E839	Disorder of mineral metabolism, unspecified	No CC/MCC	2.531	11347	n distinct hcps (+0.56), work rvu (+0.45), n j code lines (+0.38)
I519	Heart disease, unspecified	No CC/MCC	2.423	12690	n distinct rev codes (+0.49), work rvu (+0.46), n distinct hcps (+0.45)
N2581	Secondary hyperparathyroidism of renal origin	CC	2.418	88038	n distinct rev codes (+0.50), work rvu (+0.46), n distinct hcps (+0.40)
E538	Deficiency of other specified B group vitamins	No CC/MCC	2.306	121174	n distinct hcps (+0.49), work rvu (+0.45), n distinct rev codes (+0.40)

Key Driver Frequency

feature	count	pct
work rvu	162	68.600
n distinct hcps	162	68.600
n distinct rev codes	124	52.500
n j code lines	123	52.100
n imaging lines	74	31.400
or	24	10.200
icu	13	5.500
transfusion	13	5.500
organ system count	6	2.500
mechanical ventilation	6	2.500
dialysis	1	0.400