OP - NU.0.spinal_neurostimulator
CM Codes
Data Overview
2852 total codes in komodo_rii; 48 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 45 |
| CC | 3 |
PCA Analysis
PC1 explains 30.5% of variance; PC1+PC2 together explain 51.3%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | work rvu | organ system count | n j code lines | n distinct rev codes | relative claim charge | n distinct hcps | or | n imaging lines |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 4.000 | 2797.000 | 10.051 | 4.034 | 7.338 | 7.970 | 0.913 | 0.606 | 0.918 | 0.004 |
| 2 | 16.000 | 57799.000 | 13.416 | 3.885 | 8.021 | 8.201 | 1.009 | 0.648 | 0.924 | 0.003 |
| 3 | 28.000 | 46520.000 | 13.024 | 4.980 | 8.350 | 8.412 | 1.009 | 0.665 | 0.938 | 0.002 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 3 | 0 | 0 | 3 |
| No CC/MCC | 1 | 16 | 28 | 45 |
| All | 4 | 16 | 28 | 48 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_j_code_lines | 0.389 | 0.118 | -0.295 |
| avg_relative_claim_charge | 0.386 | -0.083 | -0.419 |
| avg_work_rvu | 0.383 | 0.083 | -0.419 |
| avg_n_distinct_rev_codes | 0.382 | -0.262 | -0.196 |
| avg_organ_system_count | 0.377 | -0.081 | -0.146 |
| rate_or | 0.349 | -0.338 | -0.221 |
| avg_n_distinct_hcps | 0.335 | 0.011 | -0.332 |
| 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_n_imaging_lines | -0.104 | 0.148 | 0.149 |
| rate_transfusion | -0.141 | 0.034 | 0.190 |
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 |
|---|---|---|---|---|---|---|
| E782 | Mixed hyperlipidemia | No CC/MCC | 2.562 | 3 | 692 | n j code lines (+0.52), or (+0.49), n distinct hcps (+0.49) |
| E1122 | Type 2 diabetes mellitus with diabetic chronic kidney disease | No CC/MCC | 2.445 | 3 | 1007 | n distinct rev codes (+0.86), or (+0.76), organ system count (+0.57) |
| I509 | Heart failure, unspecified | No CC/MCC | 1.752 | 3 | 629 | relative claim charge (+0.56), or (+0.55), n distinct rev codes (+0.29) |
| M1990 | Unspecified osteoarthritis, unspecified site | No CC/MCC | 1.474 | 3 | 1717 | n distinct rev codes (+0.42), n j code lines (+0.29), organ system count (+0.28) |
| I110 | Hypertensive heart disease with heart failure | No CC/MCC | 1.373 | 3 | 649 | or (+0.53), relative claim charge (+0.43), n distinct hcps (-0.31) |
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 |
|---|---|---|---|---|---|
| T85192A | Other mechanical complication of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter | CC | -3.309 | 515 | relative claim charge (-1.01), work rvu (-0.68), or (-0.64) |
| M5417 | Radiculopathy, lumbosacral region | No CC/MCC | -3.348 | 734 | n j code lines (-1.54), n distinct rev codes (-1.10), organ system count (-0.52) |
| T85113A | Breakdown (mechanical) of implanted electronic neurostimulator, generator, initial encounter | CC | -4.794 | 815 | work rvu (-1.68), relative claim charge (-1.34), n distinct rev codes (-0.59) |
| T85193A | Other mechanical complication of implanted electronic neurostimulator, generator, initial encounter | CC | -5.864 | 733 | work rvu (-1.65), relative claim charge (-1.15), n distinct hcps (-0.86) |
Tier 2 (n=16 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| M4726 | Other spondylosis with radiculopathy, lumbar region | No CC/MCC | 0.107 | 1500 | organ system count (-0.48), n distinct rev codes (+0.45), or (+0.38) |
| G629 | Polyneuropathy, unspecified | No CC/MCC | 0.081 | 1115 | n distinct rev codes (-0.48), n distinct hcps (+0.34), work rvu (+0.32) |
| E119 | Type 2 diabetes mellitus without complications | No CC/MCC | 0.040 | 3335 | n distinct rev codes (+0.51), or (-0.38), n distinct hcps (-0.11) |
| I10 | Essential (primary) hypertension | No CC/MCC | -0.115 | 9655 | or (-0.23), n distinct rev codes (-0.11), transfusion (+0.07) |
| M48062 | Spinal stenosis, lumbar region with neurogenic claudication | No CC/MCC | -0.227 | 1032 | relative claim charge (+0.59), organ system count (-0.47), work rvu (+0.35) |
| M5136 | None | No CC/MCC | -0.248 | 716 | organ system count (-0.38), work rvu (+0.24), or (-0.19) |
| M549 | Dorsalgia, unspecified | No CC/MCC | -0.267 | 739 | n j code lines (+0.70), or (-0.56), organ system count (-0.37) |
| M5412 | Radiculopathy, cervical region | No CC/MCC | -0.424 | 719 | n distinct rev codes (-0.95), n distinct hcps (+0.79), organ system count (-0.79) |
| G8929 | Other chronic pain | No CC/MCC | -0.466 | 4886 | n j code lines (+0.49), or (-0.38), organ system count (-0.30) |
| M48061 | Spinal stenosis, lumbar region without neurogenic claudication | No CC/MCC | -0.641 | 1545 | organ system count (-0.41), or (-0.29), work rvu (+0.18) |
Tier 3 (n=28 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| E782 | Mixed hyperlipidemia | No CC/MCC | 2.562 | 692 | n j code lines (+0.52), or (+0.49), n distinct hcps (+0.49) |
| E1122 | Type 2 diabetes mellitus with diabetic chronic kidney disease | No CC/MCC | 2.445 | 1007 | n distinct rev codes (+0.86), or (+0.76), organ system count (+0.57) |
| I509 | Heart failure, unspecified | No CC/MCC | 1.752 | 629 | relative claim charge (+0.56), or (+0.55), n distinct rev codes (+0.29) |
| M1990 | Unspecified osteoarthritis, unspecified site | No CC/MCC | 1.474 | 1717 | n distinct rev codes (+0.42), n j code lines (+0.29), organ system count (+0.28) |
| I110 | Hypertensive heart disease with heart failure | No CC/MCC | 1.373 | 649 | or (+0.53), relative claim charge (+0.43), n distinct hcps (-0.31) |
| E1142 | Type 2 diabetes mellitus with diabetic polyneuropathy | No CC/MCC | 1.351 | 1035 | relative claim charge (+0.79), n distinct rev codes (+0.58), work rvu (+0.40) |
| G43909 | Migraine, unspecified, not intractable, without status migrainosus | No CC/MCC | 1.342 | 573 | n distinct hcps (+0.47), n j code lines (+0.37), organ system count (+0.31) |
| E6601 | Morbid (severe) obesity due to excess calories | No CC/MCC | 1.208 | 1468 | n j code lines (+0.49), n distinct hcps (+0.18), relative claim charge (+0.14) |
| E669 | Obesity, unspecified | No CC/MCC | 1.141 | 2673 | n distinct hcps (+0.47), n j code lines (+0.28), or (+0.09) |
| I252 | Old myocardial infarction | No CC/MCC | 1.122 | 720 | n distinct hcps (+0.43), or (+0.28), transfusion (-0.23) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| organ system count | 33 | 68.800 |
| or | 28 | 58.300 |
| n distinct hcps | 20 | 41.700 |
| n j code lines | 18 | 37.500 |
| n distinct rev codes | 17 | 35.400 |
| relative claim charge | 13 | 27.100 |
| work rvu | 9 | 18.800 |
| transfusion | 5 | 10.400 |
| n imaging lines | 1 | 2.100 |
