OP - MS.0.hip_replacement

CM Codes

Data Overview

4370 total codes in komodo_rii; 68 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	61
CC	7

PCA Analysis

PC1 explains 28.6% of variance; PC1+PC2 together explain 44.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	organ system count	n distinct rev codes	work rvu	n j code lines	n distinct hcps	or	relative claim charge	transfusion
1	12.000	29436.000	3.638	10.530	23.707	10.966	0.576	0.869	1.005	0.004
2	33.000	251252.000	3.875	10.931	23.479	10.888	0.552	0.903	1.004	0.006
3	18.000	26946.000	4.509	11.145	23.249	10.965	0.489	0.926	0.999	0.008
4	5.000	4260.000	4.670	11.478	23.101	11.320	0.382	0.935	1.026	0.010

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	1	4	0	2	7
No CC/MCC	11	29	18	3	61
All	12	33	18	5	68

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.475	-0.206	-0.070
rate_or	0.455	-0.157	-0.253
avg_organ_system_count	0.350	-0.167	-0.213
rate_transfusion	0.278	-0.261	0.396
avg_n_imaging_lines	0.269	-0.294	0.324
avg_n_j_code_lines	0.123	-0.134	0.243
rate_icu	0.052	0.270	-0.105
avg_relative_claim_charge	0.035	-0.148	0.354
rate_dialysis	0.009	0.377	0.014
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	-0.349	0.059	0.060
avg_n_distinct_hcps	-0.392	0.070	-0.120

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	3.255	4	1694	n distinct rev codes (+1.08), or (+0.70), n distinct hcps (+0.65)
E1142	Type 2 diabetes mellitus with diabetic polyneuropathy	No CC/MCC	3.235	4	523	n distinct rev codes (+0.98), n imaging lines (+0.77), or (+0.59)
E1140	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	No CC/MCC	2.752	4	569	n distinct rev codes (+1.00), or (+0.62), n distinct hcps (+0.41)

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

None.

Top Codes by Tier

Tier 1 (n=12 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G43909	Migraine, unspecified, not intractable, without status migrainosus	No CC/MCC	-1.528	926	n distinct hcps (-0.43), n imaging lines (-0.34), n distinct rev codes (-0.27)
E669	Obesity, unspecified	No CC/MCC	-1.757	11386	n distinct rev codes (-0.58), n distinct hcps (-0.40), or (-0.32)
E663	Overweight	No CC/MCC	-1.789	696	or (-0.55), transfusion (-0.42), n imaging lines (-0.34)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	-1.880	949	n distinct hcps (-0.67), n distinct rev codes (-0.53), work rvu (-0.52)
M8580	Other specified disorders of bone density and structure, unspecified site	No CC/MCC	-1.958	752	n distinct hcps (-0.55), work rvu (-0.52), organ system count (-0.32)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	-2.014	4095	n distinct rev codes (-0.65), work rvu (-0.40), or (-0.37)
J4520	Mild intermittent asthma, uncomplicated	No CC/MCC	-2.259	664	n distinct rev codes (-1.20), or (-0.95), n imaging lines (-0.34)
G8918	Other acute postprocedural pain	No CC/MCC	-2.463	2219	work rvu (-1.22), or (-0.66), n distinct rev codes (-0.48)
M87851	Other osteonecrosis, right femur	CC	-2.540	787	work rvu (-0.92), or (-0.80), n distinct rev codes (-0.67)
M25752	Osteophyte, left hip	No CC/MCC	-2.758	2900	n distinct rev codes (-1.02), or (-0.81), organ system count (-0.53)

Tier 2 (n=33 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	0.474	6533	or (+0.27), n distinct rev codes (+0.23), n imaging lines (-0.17)
F32A	Depression, unspecified	No CC/MCC	0.393	4347	organ system count (+0.31), work rvu (+0.29), n distinct hcps (-0.19)
M5450	Low back pain, unspecified	No CC/MCC	0.346	549	n distinct hcps (-0.86), or (+0.68), n distinct rev codes (+0.49)
F419	Anxiety disorder, unspecified	No CC/MCC	0.171	5349	organ system count (+0.27), work rvu (+0.25), n distinct hcps (-0.24)
M87852	Other osteonecrosis, left femur	CC	0.112	711	transfusion (+1.10), organ system count (-0.59), or (-0.23)
M1990	Unspecified osteoarthritis, unspecified site	No CC/MCC	0.013	986	n distinct hcps (-0.50), transfusion (+0.35), n distinct rev codes (+0.28)
I480	Paroxysmal atrial fibrillation	No CC/MCC	0.005	1514	n distinct rev codes (-0.30), work rvu (+0.16), n distinct hcps (+0.11)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-0.063	16596	organ system count (+0.27), n imaging lines (-0.19), n distinct hcps (-0.10)
E039	Hypothyroidism, unspecified	No CC/MCC	-0.080	7787	or (+0.10), work rvu (+0.09), n distinct hcps (-0.07)
M25551	Pain in right hip	No CC/MCC	-0.091	2222	organ system count (-0.58), n distinct hcps (+0.47), n distinct rev codes (+0.38)

Tier 3 (n=18 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G2581	Restless legs syndrome	No CC/MCC	2.391	604	n imaging lines (+0.92), n distinct hcps (+0.53), organ system count (+0.42)
N1830	Chronic kidney disease, stage 3 unspecified	No CC/MCC	2.244	1384	n imaging lines (+0.77), n distinct hcps (+0.53), organ system count (+0.44)
G629	Polyneuropathy, unspecified	No CC/MCC	2.195	1049	or (+0.67), n distinct rev codes (+0.58), n imaging lines (+0.40)
I739	Peripheral vascular disease, unspecified	No CC/MCC	2.120	668	or (+0.81), n imaging lines (+0.52), transfusion (+0.41)
I129	Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	No CC/MCC	1.650	3751	organ system count (+0.46), n distinct hcps (+0.42), or (+0.40)
I509	Heart failure, unspecified	No CC/MCC	1.642	1114	or (+0.48), n distinct hcps (+0.47), n distinct rev codes (+0.32)
N1831	Chronic kidney disease, stage 3a	No CC/MCC	1.628	1009	or (+0.45), organ system count (+0.41), work rvu (+0.39)
N182	Chronic kidney disease, stage 2 (mild)	No CC/MCC	1.610	521	or (+0.70), work rvu (+0.53), organ system count (+0.42)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	1.601	3660	organ system count (+0.40), or (+0.37), n distinct rev codes (+0.35)
N189	Chronic kidney disease, unspecified	No CC/MCC	1.543	1388	or (+0.54), n distinct rev codes (+0.45), organ system count (+0.40)

Tier 4 (n=5 codes)

code	Description	CMS severity	Score	N claims	Key drivers
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	4.610	511	n distinct rev codes (+0.97), or (+0.79), n distinct hcps (+0.78)
D62	Acute posthemorrhagic anemia	CC	4.558	963	n distinct hcps (+1.75), transfusion (+0.98), work rvu (+0.87)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	3.255	1694	n distinct rev codes (+1.08), or (+0.70), n distinct hcps (+0.65)
E1142	Type 2 diabetes mellitus with diabetic polyneuropathy	No CC/MCC	3.235	523	n distinct rev codes (+0.98), n imaging lines (+0.77), or (+0.59)
E1140	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	No CC/MCC	2.752	569	n distinct rev codes (+1.00), or (+0.62), n distinct hcps (+0.41)

Key Driver Frequency

feature	count	pct
n distinct rev codes	38	55.900
or	35	51.500
n distinct hcps	34	50.000
organ system count	32	47.100
work rvu	27	39.700
n imaging lines	18	26.500
transfusion	13	19.100
n j code lines	6	8.800
icu	1	1.500