OP - NU.0.sleep_study
CM Codes
Data Overview
5627 total codes in komodo_rii; 102 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 93 |
| CC | 8 |
| MCC | 1 |
PCA Analysis
PC1 explains 32.5% of variance; PC1+PC2 together explain 48.0%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | organ system count | n distinct rev codes | n distinct hcps | work rvu | n j code lines | relative claim charge | n imaging lines | or |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 4.000 | 3265.000 | 3.566 | 1.158 | 0.632 | 2.671 | 0.021 | 1.006 | 0.012 | 0.002 |
| 2 | 34.000 | 98265.000 | 2.925 | 1.041 | 0.677 | 2.652 | 0.007 | 0.998 | 0.004 | 0.000 |
| 3 | 64.000 | 753062.000 | 2.003 | 0.964 | 0.721 | 2.646 | 0.001 | 1.012 | 0.001 | 0.000 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 0 | 4 | 4 | 8 |
| MCC | 0 | 1 | 0 | 1 |
| No CC/MCC | 4 | 29 | 60 | 93 |
| All | 4 | 34 | 64 | 102 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_distinct_hcps | 0.232 | 0.030 | -0.099 |
| avg_relative_claim_charge | 0.106 | -0.251 | 0.105 |
| avg_length_of_stay | -0.000 | nan | nan |
| rate_dialysis | -0.000 | nan | nan |
| rate_icu | -0.000 | nan | nan |
| rate_mechanical_ventilation | -0.000 | nan | nan |
| rate_multiple_or_days | 0.000 | nan | nan |
| avg_work_rvu | -0.055 | -0.013 | 0.199 |
| rate_transfusion | -0.218 | 0.101 | -0.084 |
| rate_or | -0.303 | 0.344 | 0.005 |
| avg_n_imaging_lines | -0.356 | 0.033 | -0.003 |
| avg_organ_system_count | -0.428 | -0.260 | 0.021 |
| avg_n_distinct_rev_codes | -0.476 | -0.202 | 0.212 |
| avg_n_j_code_lines | -0.507 | -0.078 | 0.145 |
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 |
|---|---|---|---|---|---|---|
| G4731 | Primary central sleep apnea | No CC/MCC | 2.307 | 3 | 6767 | relative claim charge (+0.99), organ system count (+0.55), n j code lines (+0.32) |
| G47419 | Narcolepsy without cataplexy | No CC/MCC | 1.976 | 3 | 3208 | n distinct rev codes (+0.86), organ system count (+0.72), n imaging lines (+0.21) |
| J353 | Hypertrophy of tonsils with hypertrophy of adenoids | No CC/MCC | 1.895 | 3 | 2923 | n distinct rev codes (+0.57), n j code lines (+0.38), organ system count (+0.31) |
| Q909 | Down syndrome, unspecified | No CC/MCC | 1.846 | 3 | 2126 | organ system count (+0.74), n distinct hcps (+0.50), n imaging lines (+0.17) |
| G47411 | Narcolepsy with cataplexy | No CC/MCC | 1.804 | 3 | 1264 | organ system count (+0.69), n distinct rev codes (+0.46), n j code lines (+0.24) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=4 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| M1990 | Unspecified osteoarthritis, unspecified site | No CC/MCC | -4.132 | 581 | n j code lines (-1.88), organ system count (-1.30), n distinct hcps (-0.51) |
| F17210 | Nicotine dependence, cigarettes, uncomplicated | No CC/MCC | -4.540 | 732 | n imaging lines (-2.35), n j code lines (-0.77), n distinct rev codes (-0.73) |
| E559 | Vitamin D deficiency, unspecified | No CC/MCC | -6.394 | 756 | n j code lines (-2.15), n distinct rev codes (-2.05), transfusion (-1.47) |
| G8929 | Other chronic pain | No CC/MCC | -7.579 | 1196 | or (-2.51), n j code lines (-1.78), n distinct rev codes (-1.56) |
Tier 2 (n=34 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| J4540 | Moderate persistent asthma, uncomplicated | No CC/MCC | -0.157 | 1094 | n distinct rev codes (-0.28), n j code lines (-0.10), or (+0.10) |
| F32A | Depression, unspecified | No CC/MCC | -0.241 | 4262 | organ system count (-0.56), n distinct rev codes (+0.44), n imaging lines (+0.17) |
| G3184 | Mild cognitive impairment of uncertain or unknown etiology | No CC/MCC | -0.280 | 641 | n imaging lines (-0.65), n distinct rev codes (-0.35), organ system count (+0.27) |
| I10 | Essential (primary) hypertension | No CC/MCC | -0.316 | 30223 | organ system count (-0.29), n distinct hcps (-0.16), n j code lines (+0.08) |
| F17200 | Nicotine dependence, unspecified, uncomplicated | No CC/MCC | -0.347 | 978 | organ system count (-0.44), n j code lines (+0.29), n imaging lines (-0.22) |
| J309 | Allergic rhinitis, unspecified | No CC/MCC | -0.371 | 1197 | n j code lines (-0.53), organ system count (-0.29), n distinct hcps (+0.23) |
| I5020 | Unspecified systolic (congestive) heart failure | CC | -0.428 | 591 | n distinct rev codes (-0.31), n distinct hcps (-0.28), n imaging lines (+0.21) |
| I480 | Paroxysmal atrial fibrillation | No CC/MCC | -0.455 | 3371 | n distinct rev codes (-0.30), n distinct hcps (-0.15), or (+0.10) |
| J45909 | Unspecified asthma, uncomplicated | No CC/MCC | -0.456 | 4157 | organ system count (-0.45), n j code lines (-0.27), n distinct hcps (+0.16) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | -0.635 | 5348 | organ system count (-0.46), n j code lines (-0.27), n distinct rev codes (+0.23) |
Tier 3 (n=64 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| G4731 | Primary central sleep apnea | No CC/MCC | 2.307 | 6767 | relative claim charge (+0.99), organ system count (+0.55), n j code lines (+0.32) |
| G47419 | Narcolepsy without cataplexy | No CC/MCC | 1.976 | 3208 | n distinct rev codes (+0.86), organ system count (+0.72), n imaging lines (+0.21) |
| J353 | Hypertrophy of tonsils with hypertrophy of adenoids | No CC/MCC | 1.895 | 2923 | n distinct rev codes (+0.57), n j code lines (+0.38), organ system count (+0.31) |
| Q909 | Down syndrome, unspecified | No CC/MCC | 1.846 | 2126 | organ system count (+0.74), n distinct hcps (+0.50), n imaging lines (+0.17) |
| G47411 | Narcolepsy with cataplexy | No CC/MCC | 1.804 | 1264 | organ system count (+0.69), n distinct rev codes (+0.46), n j code lines (+0.24) |
| J351 | Hypertrophy of tonsils | No CC/MCC | 1.732 | 9646 | n distinct rev codes (+0.42), n j code lines (+0.38), n distinct hcps (+0.31) |
| F514 | Sleep terrors [night terrors] | No CC/MCC | 1.705 | 746 | n distinct rev codes (+0.56), n j code lines (+0.38), n imaging lines (+0.21) |
| G4711 | Idiopathic hypersomnia with long sleep time | No CC/MCC | 1.690 | 1080 | organ system count (+0.69), n distinct rev codes (+0.40), n j code lines (+0.30) |
| G4739 | Other sleep apnea | No CC/MCC | 1.678 | 5456 | organ system count (+0.64), n distinct hcps (+0.50), n j code lines (+0.25) |
| G4769 | Other sleep related movement disorders | No CC/MCC | 1.654 | 958 | organ system count (+0.53), n distinct rev codes (+0.37), n j code lines (+0.29) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n j code lines | 80 | 78.400 |
| n distinct rev codes | 66 | 64.700 |
| organ system count | 63 | 61.800 |
| n distinct hcps | 41 | 40.200 |
| n imaging lines | 36 | 35.300 |
| or | 14 | 13.700 |
| transfusion | 3 | 2.900 |
| relative claim charge | 2 | 2.000 |
| work rvu | 1 | 1.000 |
