OP - ON.1.breast_reconstruction

CM Codes

Data Overview

2441 total codes in komodo_rii; 42 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	37
CC	5

PCA Analysis

PC1 explains 48.4% of variance; PC1+PC2 together explain 68.6%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n j code lines	organ system count	n distinct rev codes	relative claim charge	or	n distinct hcps	n imaging lines
1	25.000	46158.000	31.175	11.323	3.699	8.354	0.953	0.858	0.737	0.001
2	6.000	5751.000	43.461	12.021	2.769	8.447	1.148	0.763	0.695	0.000
3	11.000	10198.000	49.873	12.607	2.514	8.953	1.298	0.765	0.736	0.000

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	4	0	1	5
No CC/MCC	21	6	10	37
All	25	6	11	42

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.474	-0.340	-0.331
avg_relative_claim_charge	0.460	-0.340	-0.337
avg_n_j_code_lines	0.424	-0.258	-0.349
avg_n_distinct_rev_codes	0.327	-0.200	-0.270
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_distinct_hcps	-0.004	0.021	-0.191
rate_transfusion	-0.010	-0.069	-0.240
avg_n_imaging_lines	-0.103	0.527	-0.080
avg_organ_system_count	-0.348	0.050	-0.094
rate_or	-0.381	0.266	0.094

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
D242	Benign neoplasm of left breast	No CC/MCC	3.307	3	635	n j code lines (+1.03), work rvu (+0.72), relative claim charge (+0.54)
C50812	Malignant neoplasm of overlapping sites of left female breast	No CC/MCC	3.111	3	751	n j code lines (+0.73), work rvu (+0.68), n distinct rev codes (+0.59)
D0511	Intraductal carcinoma in situ of right breast	No CC/MCC	2.934	3	1119	relative claim charge (+0.72), work rvu (+0.60), n j code lines (+0.60)
C50412	Malignant neoplasm of upper-outer quadrant of left female breast	No CC/MCC	2.919	3	1080	relative claim charge (+0.75), work rvu (+0.63), n distinct rev codes (+0.52)
D241	Benign neoplasm of right breast	No CC/MCC	2.899	3	666	work rvu (+0.76), n j code lines (+0.67), relative claim charge (+0.60)

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

None.

Top Codes by Tier

Tier 1 (n=25 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D649	Anemia, unspecified	No CC/MCC	-0.523	542	organ system count (-0.30), or (-0.24), n j code lines (+0.21)
N641	Fat necrosis of breast	No CC/MCC	-0.625	521	relative claim charge (-0.25), work rvu (-0.22), n j code lines (-0.21)
E669	Obesity, unspecified	No CC/MCC	-0.828	1768	work rvu (-0.23), or (-0.21), relative claim charge (-0.20)
N6489	Other specified disorders of breast	No CC/MCC	-1.108	2764	relative claim charge (-0.38), work rvu (-0.37), n distinct rev codes (-0.36)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-1.207	1466	n distinct rev codes (+0.40), n j code lines (-0.38), work rvu (-0.37)
I10	Essential (primary) hypertension	No CC/MCC	-1.246	5528	work rvu (-0.29), organ system count (-0.28), or (-0.26)
F419	Anxiety disorder, unspecified	No CC/MCC	-1.268	2007	or (-0.42), organ system count (-0.38), work rvu (-0.27)
E785	Hyperlipidemia, unspecified	No CC/MCC	-1.453	2503	organ system count (-0.37), or (-0.36), work rvu (-0.30)
E039	Hypothyroidism, unspecified	No CC/MCC	-1.464	2176	work rvu (-0.35), n j code lines (-0.32), relative claim charge (-0.24)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-1.486	3685	organ system count (-0.49), or (-0.37), work rvu (-0.29)

Tier 2 (n=6 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N62	Hypertrophy of breast	No CC/MCC	2.013	511	work rvu (+0.59), or (+0.42), relative claim charge (+0.34)
C50911	Malignant neoplasm of unspecified site of right female breast	No CC/MCC	1.400	1733	organ system count (+0.31), n j code lines (+0.30), work rvu (+0.27)
C50912	Malignant neoplasm of unspecified site of left female breast	No CC/MCC	1.324	1673	organ system count (+0.34), or (+0.31), work rvu (+0.29)
N6481	Ptosis of breast	No CC/MCC	1.238	697	n j code lines (+0.42), or (+0.38), n distinct rev codes (-0.34)
N6031	Fibrosclerosis of right breast	No CC/MCC	0.921	586	or (+0.53), work rvu (+0.31), n distinct rev codes (-0.21)
N6032	Fibrosclerosis of left breast	No CC/MCC	0.861	551	or (+0.65), n distinct rev codes (-0.24), organ system count (+0.21)

Tier 3 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C773	Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes	CC	3.764	1478	work rvu (+0.85), relative claim charge (+0.78), n j code lines (+0.69)
D242	Benign neoplasm of left breast	No CC/MCC	3.307	635	n j code lines (+1.03), work rvu (+0.72), relative claim charge (+0.54)
C50812	Malignant neoplasm of overlapping sites of left female breast	No CC/MCC	3.111	751	n j code lines (+0.73), work rvu (+0.68), n distinct rev codes (+0.59)
D0511	Intraductal carcinoma in situ of right breast	No CC/MCC	2.934	1119	relative claim charge (+0.72), work rvu (+0.60), n j code lines (+0.60)
C50412	Malignant neoplasm of upper-outer quadrant of left female breast	No CC/MCC	2.919	1080	relative claim charge (+0.75), work rvu (+0.63), n distinct rev codes (+0.52)
D241	Benign neoplasm of right breast	No CC/MCC	2.899	666	work rvu (+0.76), n j code lines (+0.67), relative claim charge (+0.60)
C50411	Malignant neoplasm of upper-outer quadrant of right female breast	No CC/MCC	2.885	1225	work rvu (+0.68), relative claim charge (+0.59), n j code lines (+0.43)
N6012	Diffuse cystic mastopathy of left breast	No CC/MCC	2.855	598	relative claim charge (+0.89), or (+0.82), work rvu (+0.65)
N6011	Diffuse cystic mastopathy of right breast	No CC/MCC	2.832	673	or (+0.96), relative claim charge (+0.85), work rvu (+0.56)
D0512	Intraductal carcinoma in situ of left breast	No CC/MCC	2.681	1134	work rvu (+0.59), relative claim charge (+0.57), n j code lines (+0.41)

Key Driver Frequency

feature	count	pct
work rvu	37	88.100
relative claim charge	22	52.400
n j code lines	20	47.600
or	19	45.200
organ system count	14	33.300
n distinct rev codes	12	28.600
n imaging lines	2	4.800