OP - MS.0.cervical_ACDF

CM Codes

Data Overview

2296 total codes in komodo_rii; 37 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	31
CC	6

PCA Analysis

PC1 explains 28.7% of variance; PC1+PC2 together explain 50.9%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	organ system count	n distinct rev codes	n j code lines	work rvu	or	n distinct hcps	relative claim charge	n imaging lines
1	5.000	10055.000	2.881	8.772	10.356	42.505	0.796	0.478	1.012	0.004
2	11.000	29514.000	3.437	9.128	10.733	42.526	0.839	0.492	1.004	0.007
3	7.000	14490.000	4.232	9.207	10.710	41.913	0.861	0.497	0.993	0.007
4	10.000	18301.000	3.918	9.347	11.030	42.116	0.871	0.471	1.016	0.007
5	4.000	3492.000	4.426	9.713	11.174	42.643	0.891	0.418	1.014	0.008

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	0	4	0	2	0	6
No CC/MCC	5	7	7	8	4	31
All	5	11	7	10	4	37

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
rate_or	0.553	-0.259	-0.096
avg_n_distinct_rev_codes	0.505	-0.226	0.254
avg_n_j_code_lines	0.405	0.060	-0.103
avg_organ_system_count	0.378	0.067	-0.323
rate_transfusion	0.186	-0.066	0.007
avg_n_imaging_lines	0.176	0.063	0.041
rate_icu	0.169	0.160	-0.263
avg_relative_claim_charge	0.041	-0.131	0.048
avg_length_of_stay	-0.000	nan	nan
rate_dialysis	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_work_rvu	-0.097	-0.031	0.295
avg_n_distinct_hcps	-0.164	0.142	-0.165

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	2.868	5	1131	n distinct rev codes (+0.87), or (+0.78), organ system count (+0.60)
M542	Cervicalgia	No CC/MCC	2.775	5	553	n distinct rev codes (+1.01), n j code lines (+0.82), transfusion (+0.41)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	2.594	5	1199	or (+0.88), n distinct rev codes (+0.82), n j code lines (+0.41)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	2.531	5	609	or (+0.99), n distinct rev codes (+0.85), organ system count (+0.75)

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

None.

Top Codes by Tier

Tier 1 (n=5 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M2578	Osteophyte, vertebrae	No CC/MCC	-2.365	3190	or (-0.92), n distinct rev codes (-0.64), organ system count (-0.40)
M50121	Cervical disc disorder at C4-C5 level with radiculopathy	No CC/MCC	-2.687	1221	or (-0.85), n j code lines (-0.64), n distinct rev codes (-0.57)
M50122	Cervical disc disorder at C5-C6 level with radiculopathy	No CC/MCC	-3.172	2882	or (-1.06), n distinct rev codes (-0.70), organ system count (-0.52)
M50123	Cervical disc disorder at C6-C7 level with radiculopathy	No CC/MCC	-3.648	2211	or (-1.03), n distinct rev codes (-0.94), n j code lines (-0.58)
M50222	Other cervical disc displacement at C5-C6 level	No CC/MCC	-4.169	551	or (-1.37), n distinct rev codes (-1.14), n j code lines (-0.76)

Tier 2 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M47812	Spondylosis without myelopathy or radiculopathy, cervical region	No CC/MCC	-0.454	778	organ system count (-0.36), n distinct rev codes (-0.22), n imaging lines (+0.21)
M50021	Cervical disc disorder at C4-C5 level with myelopathy	CC	-0.478	733	organ system count (-0.42), n j code lines (-0.31), transfusion (+0.27)
G4730	Sleep apnea, unspecified	No CC/MCC	-0.510	943	n distinct rev codes (-0.72), n distinct hcps (-0.41), organ system count (+0.38)
M4802	Spinal stenosis, cervical region	No CC/MCC	-0.577	12769	or (-0.38), organ system count (-0.31), n distinct hcps (+0.16)
E669	Obesity, unspecified	No CC/MCC	-0.730	1737	n distinct rev codes (-0.26), n distinct hcps (-0.24), or (-0.22)
G992	Myelopathy in diseases classified elsewhere	CC	-0.928	728	n j code lines (+0.47), or (-0.44), n imaging lines (-0.38)
M4722	Other spondylosis with radiculopathy, cervical region	No CC/MCC	-0.936	5083	or (-0.54), organ system count (-0.42), n j code lines (+0.20)
M50022	Cervical disc disorder at C5-C6 level with myelopathy	CC	-1.000	1090	organ system count (-0.40), or (-0.35), n j code lines (-0.32)
F17210	Nicotine dependence, cigarettes, uncomplicated	No CC/MCC	-1.054	1577	n distinct rev codes (-0.45), or (-0.31), organ system count (+0.18)
M50023	Cervical disc disorder at C6-C7 level with myelopathy	CC	-1.205	511	n j code lines (-0.77), organ system count (-0.45), n imaging lines (+0.44)

Tier 3 (n=7 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J45909	Unspecified asthma, uncomplicated	No CC/MCC	0.630	1302	organ system count (+0.40), n distinct hcps (-0.32), or (+0.30)
F32A	Depression, unspecified	No CC/MCC	0.607	1302	organ system count (+0.45), n j code lines (+0.26), transfusion (-0.16)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	0.377	1487	organ system count (+0.46), transfusion (-0.28), n j code lines (+0.15)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	0.370	1183	or (+0.72), n j code lines (-0.55), organ system count (+0.28)
M5011	Cervical disc disorder with radiculopathy, high cervical region	No CC/MCC	0.302	592	n j code lines (-0.69), icu (+0.59), organ system count (-0.32)
I10	Essential (primary) hypertension	No CC/MCC	0.298	7037	organ system count (+0.18), n j code lines (+0.06), n imaging lines (+0.06)
F419	Anxiety disorder, unspecified	No CC/MCC	0.076	1587	organ system count (+0.41), work rvu (+0.17), n distinct rev codes (-0.15)

Tier 4 (n=10 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E039	Hypothyroidism, unspecified	No CC/MCC	1.465	1288	or (+0.43), organ system count (+0.28), icu (+0.25)
M5001	Cervical disc disorder with myelopathy, high cervical region	CC	1.390	677	transfusion (+0.68), or (+0.65), n distinct rev codes (+0.57)
E785	Hyperlipidemia, unspecified	No CC/MCC	1.379	3256	organ system count (+0.33), n imaging lines (+0.30), n j code lines (+0.22)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	1.323	907	or (+0.62), n distinct rev codes (+0.24), work rvu (+0.19)
M4712	Other spondylosis with myelopathy, cervical region	CC	1.192	3249	n j code lines (+0.57), n distinct rev codes (+0.49), organ system count (-0.32)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	1.136	2450	n distinct rev codes (+0.72), or (+0.35), n j code lines (-0.11)
G8929	Other chronic pain	No CC/MCC	1.039	978	n j code lines (+0.64), organ system count (+0.29), n distinct rev codes (-0.16)
M4312	Spondylolisthesis, cervical region	No CC/MCC	0.947	825	n j code lines (+0.64), n distinct rev codes (+0.45), organ system count (-0.37)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	0.941	3989	organ system count (+0.47), or (+0.27), n j code lines (+0.20)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	0.910	682	icu (+0.56), or (+0.45), n j code lines (+0.42)

Tier 5 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	2.868	1131	n distinct rev codes (+0.87), or (+0.78), organ system count (+0.60)
M542	Cervicalgia	No CC/MCC	2.775	553	n distinct rev codes (+1.01), n j code lines (+0.82), transfusion (+0.41)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	2.594	1199	or (+0.88), n distinct rev codes (+0.82), n j code lines (+0.41)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	2.531	609	or (+0.99), n distinct rev codes (+0.85), organ system count (+0.75)

Key Driver Frequency

feature	count	pct
organ system count	26	70.300
or	23	62.200
n j code lines	22	59.500
n distinct rev codes	21	56.800
transfusion	5	13.500
n imaging lines	5	13.500
n distinct hcps	4	10.800
icu	3	8.100
work rvu	2	5.400