OP - MS.0.shoulder_repair

CM Codes

Data Overview

6558 total codes in komodo_rii; 177 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	169
CC	8

PCA Analysis

PC1 explains 37.5% of variance; PC1+PC2 together explain 48.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	organ system count	n j code lines	relative claim charge	or	n distinct hcps	n imaging lines
1	75.000	565608.000	31.185	7.466	3.179	9.356	0.948	0.824	0.721	0.001
2	72.000	601820.000	29.131	8.398	4.451	10.063	1.039	0.894	0.686	0.001
3	30.000	46795.000	28.628	9.126	4.653	10.465	1.146	0.923	0.628	0.003

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	0	2	6	8
No CC/MCC	75	70	24	169
All	75	72	30	177

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.464	-0.224	0.252
avg_relative_claim_charge	0.392	-0.281	0.271
rate_or	0.366	-0.274	0.146
avg_organ_system_count	0.335	-0.225	-0.024
rate_transfusion	0.322	-0.055	0.241
avg_n_j_code_lines	0.307	-0.233	0.249
avg_n_imaging_lines	0.245	0.038	0.144
rate_icu	0.076	0.304	0.044
rate_dialysis	0.061	0.242	-0.064
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	-0.221	0.293	-0.233
avg_n_distinct_hcps	-0.262	-0.070	-0.283

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
M12811	Other specific arthropathies, not elsewhere classified, right shoulder	No CC/MCC	3.965	3	3997	relative claim charge (+1.32), n distinct rev codes (+1.06), n distinct hcps (+0.53)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	3.440	3	514	n imaging lines (+1.23), relative claim charge (+0.70), n distinct rev codes (+0.58)
M12812	Other specific arthropathies, not elsewhere classified, left shoulder	No CC/MCC	3.345	3	2410	relative claim charge (+1.40), n distinct rev codes (+1.02), n distinct hcps (+0.55)
N1832	Chronic kidney disease, stage 3b	No CC/MCC	3.240	3	553	n distinct rev codes (+0.87), relative claim charge (+0.51), transfusion (+0.48)
N1831	Chronic kidney disease, stage 3a	No CC/MCC	3.025	3	1550	n distinct rev codes (+0.62), organ system count (+0.48), or (+0.42)

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

None.

Top Codes by Tier

Tier 1 (n=75 codes)

code	Description	CMS severity	Score	N claims	Key drivers
G8918	Other acute postprocedural pain	No CC/MCC	-0.676	26233	transfusion (-0.15), n distinct hcps (-0.13), or (-0.11)
F17290	Nicotine dependence, other tobacco product, uncomplicated	No CC/MCC	-0.685	2668	transfusion (-0.25), n distinct hcps (-0.23), n distinct rev codes (-0.21)
S43004A	Unspecified dislocation of right shoulder joint, initial encounter	No CC/MCC	-0.708	549	organ system count (-0.49), transfusion (+0.43), n distinct rev codes (-0.42)
S43422A	Sprain of left rotator cuff capsule, initial encounter	No CC/MCC	-0.835	545	n j code lines (-0.30), transfusion (+0.28), n imaging lines (-0.18)
F17220	Nicotine dependence, chewing tobacco, uncomplicated	No CC/MCC	-0.947	947	n distinct hcps (-0.38), or (+0.27), transfusion (-0.25)
M75122	Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic	No CC/MCC	-1.030	23370	organ system count (-0.32), work rvu (-0.24), n j code lines (-0.23)
F1290	Cannabis use, unspecified, uncomplicated	No CC/MCC	-1.113	1218	or (-0.85), n distinct rev codes (-0.41), n j code lines (+0.21)
S46011D	Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter	No CC/MCC	-1.126	1012	n distinct hcps (-0.43), n j code lines (+0.34), work rvu (-0.26)
M75121	Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic	No CC/MCC	-1.207	37930	organ system count (-0.33), work rvu (-0.25), n j code lines (-0.20)
F909	Attention-deficit hyperactivity disorder, unspecified type	No CC/MCC	-1.225	1149	n distinct rev codes (-0.51), work rvu (+0.28), transfusion (-0.25)

Tier 2 (n=72 codes)

code	Description	CMS severity	Score	N claims	Key drivers
M810	Age-related osteoporosis without current pathological fracture	No CC/MCC	1.819	2500	n distinct rev codes (+0.58), relative claim charge (+0.45), or (+0.32)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	1.816	9073	organ system count (+0.45), n distinct rev codes (+0.40), or (+0.34)
I110	Hypertensive heart disease with heart failure	No CC/MCC	1.786	3036	n distinct rev codes (+0.56), n distinct hcps (+0.27), n j code lines (+0.27)
I499	Cardiac arrhythmia, unspecified	No CC/MCC	1.694	516	dialysis (+0.69), n imaging lines (+0.47), or (+0.23)
M5450	Low back pain, unspecified	No CC/MCC	1.685	683	n imaging lines (+0.81), relative claim charge (+0.41), organ system count (+0.40)
N182	Chronic kidney disease, stage 2 (mild)	No CC/MCC	1.620	896	organ system count (+0.50), transfusion (+0.41), n distinct rev codes (+0.29)
I480	Paroxysmal atrial fibrillation	No CC/MCC	1.562	2379	n distinct rev codes (+0.49), n j code lines (+0.31), or (+0.28)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	1.538	1129	n distinct rev codes (+0.55), n j code lines (+0.33), n distinct hcps (+0.28)
I4891	Unspecified atrial fibrillation	No CC/MCC	1.538	4290	n distinct rev codes (+0.50), relative claim charge (+0.34), or (+0.33)
I739	Peripheral vascular disease, unspecified	No CC/MCC	1.515	1080	n distinct rev codes (+0.51), or (+0.46), n j code lines (+0.32)

Tier 3 (n=30 codes)

code	Description	CMS severity	Score	N claims	Key drivers
S42201A	Unspecified fracture of upper end of right humerus, initial encounter for closed fracture	CC	9.119	556	transfusion (+2.62), relative claim charge (+2.04), n distinct rev codes (+1.52)
S42202A	Unspecified fracture of upper end of left humerus, initial encounter for closed fracture	CC	5.794	507	relative claim charge (+1.92), n distinct rev codes (+1.36), n distinct hcps (+0.82)
T84028A	Dislocation of other internal joint prosthesis, initial encounter	CC	4.016	534	n distinct rev codes (+1.22), icu (+0.92), n j code lines (+0.48)
M12811	Other specific arthropathies, not elsewhere classified, right shoulder	No CC/MCC	3.965	3997	relative claim charge (+1.32), n distinct rev codes (+1.06), n distinct hcps (+0.53)
I2720	Pulmonary hypertension, unspecified	No CC/MCC	3.440	514	n imaging lines (+1.23), relative claim charge (+0.70), n distinct rev codes (+0.58)
M12812	Other specific arthropathies, not elsewhere classified, left shoulder	No CC/MCC	3.345	2410	relative claim charge (+1.40), n distinct rev codes (+1.02), n distinct hcps (+0.55)
N1832	Chronic kidney disease, stage 3b	No CC/MCC	3.240	553	n distinct rev codes (+0.87), relative claim charge (+0.51), transfusion (+0.48)
N1831	Chronic kidney disease, stage 3a	No CC/MCC	3.025	1550	n distinct rev codes (+0.62), organ system count (+0.48), or (+0.42)
M19111	Post-traumatic osteoarthritis, right shoulder	No CC/MCC	3.014	602	relative claim charge (+0.95), n distinct rev codes (+0.85), transfusion (+0.69)
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	2.966	1033	n distinct rev codes (+0.78), organ system count (+0.50), or (+0.47)

Key Driver Frequency

feature	count	pct
n distinct rev codes	121	68.400
organ system count	102	57.600
or	74	41.800
relative claim charge	59	33.300
n j code lines	44	24.900
n distinct hcps	41	23.200
transfusion	36	20.300
work rvu	31	17.500
n imaging lines	17	9.600
icu	4	2.300
dialysis	2	1.100

PCS Codes

Data Overview

104 total codes in komodo_rii; 3 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 66.7% of variance; PC1+PC2 together explain 100.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	relative claim charge	organ system count	n distinct rev codes	n distinct hcps	or	transfusion
1	1.000	721.000	28.560	9.663	0.770	3.189	3.102	0.183	0.324	0.000
2	1.000	1405.000	29.856	9.223	0.817	3.233	3.028	0.221	0.343	0.001
3	1.000	2527.000	31.342	9.180	0.948	3.097	3.002	0.256	0.332	0.000

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_hcps	0.431	1.000
avg_work_rvu	0.429	1.000
avg_relative_claim_charge	0.404	1.000
rate_or	0.229	0.500
rate_transfusion	0.045	0.000
avg_length_of_stay	0.000	nan
avg_n_imaging_lines	0.000	nan
rate_dialysis	0.000	nan
rate_icu	0.000	nan
rate_mechanical_ventilation	0.000	nan
rate_multiple_or_days	0.000	nan
avg_organ_system_count	-0.253	-0.500
avg_n_j_code_lines	-0.408	-1.000
avg_n_distinct_rev_codes	-0.427	-1.000

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=1 codes)

code	Description	Score	N claims	Key drivers
0RBJ4ZZ	EXCISION OF RIGHT SHOULDER JOINT, PERCUTANEOUS ENDOSCOPIC APPROACH	-2.983	721	n distinct rev codes (-0.58), n j code lines (-0.58), n distinct hcps (-0.53)

Tier 2 (n=1 codes)

code	Description	Score	N claims	Key drivers
0RJJ4ZZ	INSPECTION OF RIGHT SHOULDER JOINT, PERCUTANEOUS ENDOSCOPIC APPROACH	0.337	1405	or (+0.29), organ system count (-0.27), n j code lines (+0.25)

Tier 3 (n=1 codes)

code	Description	Score	N claims	Key drivers
0LQ14ZZ	REPAIR RIGHT SHOULDER TENDON, PERCUTANEOUS ENDOSCOPIC APPROACH	2.646	2527	relative claim charge (+0.55), work rvu (+0.54), n distinct hcps (+0.52)

Key Driver Frequency

feature	count	pct
n j code lines	2	66.700
n distinct hcps	2	66.700
n distinct rev codes	1	33.300
or	1	33.300
organ system count	1	33.300
relative claim charge	1	33.300
work rvu	1	33.300