OP - ON.0.imrt
CM Codes
Data Overview
8087 total codes in komodo_rii; 209 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 136 |
| CC | 73 |
PCA Analysis
PC1 explains 35.6% of variance; PC1+PC2 together explain 49.9%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | n distinct rev codes | n j code lines | organ system count | relative claim charge | work rvu | n distinct hcps | transfusion | n imaging lines |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 91.000 | 2021730.000 | 1.240 | 0.108 | 1.602 | 0.947 | 0.116 | 0.577 | 0.001 | 0.015 |
| 2 | 101.000 | 1165708.000 | 1.845 | 0.595 | 2.319 | 1.208 | 0.201 | 0.493 | 0.002 | 0.019 |
| 3 | 17.000 | 116045.000 | 3.033 | 1.395 | 2.554 | 1.442 | 0.358 | 0.498 | 0.011 | 0.020 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 39 | 33 | 1 | 73 |
| No CC/MCC | 52 | 68 | 16 | 136 |
| All | 91 | 101 | 17 | 209 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_distinct_rev_codes | 0.465 | -0.092 | -0.143 |
| avg_n_j_code_lines | 0.446 | -0.076 | -0.130 |
| avg_work_rvu | 0.427 | -0.130 | -0.063 |
| avg_relative_claim_charge | 0.407 | -0.070 | -0.087 |
| rate_transfusion | 0.289 | -0.055 | 0.061 |
| rate_or | 0.268 | -0.045 | -0.236 |
| avg_organ_system_count | 0.189 | -0.184 | -0.220 |
| avg_n_imaging_lines | 0.135 | -0.009 | 0.283 |
| rate_mechanical_ventilation | 0.070 | 0.031 | -0.102 |
| rate_dialysis | 0.023 | -0.011 | -0.030 |
| avg_length_of_stay | 0.000 | nan | nan |
| rate_multiple_or_days | 0.000 | nan | nan |
| rate_icu | -0.013 | 0.143 | 0.134 |
| avg_n_distinct_hcps | -0.150 | 0.106 | 0.233 |
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 |
|---|---|---|---|---|---|---|
| E8342 | Hypomagnesemia | No CC/MCC | 7.404 | 3 | 6662 | n j code lines (+2.01), n distinct rev codes (+1.77), work rvu (+1.33) |
| D6481 | Anemia due to antineoplastic chemotherapy | No CC/MCC | 7.339 | 3 | 3542 | transfusion (+2.57), n distinct rev codes (+1.50), n j code lines (+1.20) |
| D649 | Anemia, unspecified | No CC/MCC | 6.520 | 3 | 8583 | transfusion (+2.52), n distinct rev codes (+1.02), work rvu (+0.71) |
| T451X5A | Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter | No CC/MCC | 6.088 | 3 | 11964 | n distinct rev codes (+1.54), n j code lines (+1.36), work rvu (+1.16) |
| E876 | Hypokalemia | No CC/MCC | 5.840 | 3 | 4992 | n distinct rev codes (+1.51), n j code lines (+1.37), work rvu (+1.27) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=91 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| C7989 | Secondary malignant neoplasm of other specified sites | CC | -0.523 | 19823 | n distinct hcps (-0.16), or (-0.10), organ system count (-0.09) |
| C220 | Liver cell carcinoma | CC | -0.531 | 2442 | work rvu (+0.37), n j code lines (-0.31), n distinct rev codes (-0.25) |
| K760 | Fatty (change of) liver, not elsewhere classified | No CC/MCC | -0.531 | 2821 | organ system count (+0.27), n j code lines (-0.26), n distinct hcps (-0.24) |
| C300 | Malignant neoplasm of nasal cavity | No CC/MCC | -0.581 | 6953 | relative claim charge (+0.19), n distinct hcps (-0.17), work rvu (-0.14) |
| M069 | Rheumatoid arthritis, unspecified | No CC/MCC | -0.628 | 2774 | work rvu (-0.36), relative claim charge (-0.31), organ system count (+0.31) |
| C148 | Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx | No CC/MCC | -0.629 | 2655 | n imaging lines (-0.22), relative claim charge (+0.18), work rvu (-0.16) |
| C73 | Malignant neoplasm of thyroid gland | No CC/MCC | -0.663 | 7840 | n j code lines (-0.18), n distinct hcps (-0.17), dialysis (+0.16) |
| M810 | Age-related osteoporosis without current pathological fracture | No CC/MCC | -0.665 | 4113 | relative claim charge (-0.39), organ system count (+0.32), n j code lines (-0.24) |
| C642 | Malignant neoplasm of left kidney, except renal pelvis | CC | -0.676 | 2640 | relative claim charge (-0.33), n imaging lines (+0.23), or (-0.22) |
| C250 | Malignant neoplasm of head of pancreas | CC | -0.692 | 13778 | n j code lines (-0.35), work rvu (-0.14), or (-0.12) |
Tier 2 (n=101 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| C159 | Malignant neoplasm of esophagus, unspecified | CC | 2.669 | 10176 | n j code lines (+0.87), n distinct rev codes (+0.70), work rvu (+0.53) |
| K5900 | Constipation, unspecified | No CC/MCC | 2.664 | 10005 | n distinct rev codes (+0.71), work rvu (+0.57), n j code lines (+0.56) |
| G893 | Neoplasm related pain (acute) (chronic) | No CC/MCC | 2.572 | 23286 | n distinct rev codes (+0.69), work rvu (+0.65), or (+0.53) |
| C029 | Malignant neoplasm of tongue, unspecified | No CC/MCC | 2.307 | 7697 | work rvu (+0.75), n j code lines (+0.55), relative claim charge (+0.47) |
| G629 | Polyneuropathy, unspecified | No CC/MCC | 2.238 | 4433 | work rvu (+0.58), n distinct rev codes (+0.47), organ system count (+0.34) |
| C329 | Malignant neoplasm of larynx, unspecified | No CC/MCC | 2.219 | 13055 | n j code lines (+0.59), work rvu (+0.54), n distinct rev codes (+0.45) |
| C519 | Malignant neoplasm of vulva, unspecified | No CC/MCC | 2.193 | 7521 | n j code lines (+0.52), or (+0.44), relative claim charge (+0.40) |
| C118 | Malignant neoplasm of overlapping sites of nasopharynx | No CC/MCC | 2.140 | 3380 | n j code lines (+0.57), work rvu (+0.52), n imaging lines (+0.49) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 1.962 | 7820 | work rvu (+0.56), organ system count (+0.35), n distinct rev codes (+0.34) |
| B977 | Papillomavirus as the cause of diseases classified elsewhere | No CC/MCC | 1.955 | 3109 | n j code lines (+0.47), n distinct rev codes (+0.46), relative claim charge (+0.42) |
Tier 3 (n=17 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| E8342 | Hypomagnesemia | No CC/MCC | 7.404 | 6662 | n j code lines (+2.01), n distinct rev codes (+1.77), work rvu (+1.33) |
| D6481 | Anemia due to antineoplastic chemotherapy | No CC/MCC | 7.339 | 3542 | transfusion (+2.57), n distinct rev codes (+1.50), n j code lines (+1.20) |
| D649 | Anemia, unspecified | No CC/MCC | 6.520 | 8583 | transfusion (+2.52), n distinct rev codes (+1.02), work rvu (+0.71) |
| E871 | Hypo-osmolality and hyponatremia | CC | 6.228 | 2833 | n distinct rev codes (+1.66), work rvu (+1.65), n j code lines (+1.15) |
| T451X5A | Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter | No CC/MCC | 6.088 | 11964 | n distinct rev codes (+1.54), n j code lines (+1.36), work rvu (+1.16) |
| E876 | Hypokalemia | No CC/MCC | 5.840 | 4992 | n distinct rev codes (+1.51), n j code lines (+1.37), work rvu (+1.27) |
| D701 | Agranulocytosis secondary to cancer chemotherapy | No CC/MCC | 4.915 | 3913 | n distinct rev codes (+1.33), n j code lines (+0.99), work rvu (+0.80) |
| D500 | Iron deficiency anemia secondary to blood loss (chronic) | No CC/MCC | 4.385 | 2898 | n distinct rev codes (+1.21), transfusion (+1.05), n j code lines (+0.95) |
| D696 | Thrombocytopenia, unspecified | No CC/MCC | 4.334 | 4152 | n distinct rev codes (+1.18), work rvu (+0.98), transfusion (+0.65) |
| E860 | Dehydration | No CC/MCC | 4.116 | 10196 | n distinct rev codes (+1.34), work rvu (+0.99), n j code lines (+0.98) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n j code lines | 140 | 67.000 |
| n distinct rev codes | 122 | 58.400 |
| work rvu | 115 | 55.000 |
| relative claim charge | 102 | 48.800 |
| organ system count | 42 | 20.100 |
| n distinct hcps | 39 | 18.700 |
| or | 34 | 16.300 |
| n imaging lines | 20 | 9.600 |
| transfusion | 8 | 3.800 |
| mechanical ventilation | 3 | 1.400 |
| dialysis | 1 | 0.500 |
| icu | 1 | 0.500 |
