OP - OP.0.cataract_removal
CM Codes
Data Overview
8307 total codes in komodo_rii; 235 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 219 |
| CC | 15 |
| MCC | 1 |
PCA Analysis
PC1 explains 25.6% of variance; PC1+PC2 together explain 43.5%.
Tier Clustering (k=3)
Tier Summary
| tier | n_codes | n_claims | work rvu | n j code lines | organ system count | n distinct rev codes | n distinct hcps | relative claim charge | or | n imaging lines |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 97.000 | 1508150.000 | 8.257 | 3.138 | 3.570 | 6.493 | 0.725 | 0.992 | 0.935 | 0.000 |
| 2 | 133.000 | 977161.000 | 8.777 | 3.603 | 4.278 | 6.873 | 0.779 | 1.021 | 0.948 | 0.000 |
| 3 | 5.000 | 6471.000 | 13.375 | 5.017 | 2.787 | 7.428 | 1.041 | 1.153 | 0.927 | 0.000 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | All |
|---|---|---|---|---|
| CC | 2 | 13 | 0 | 15 |
| MCC | 0 | 1 | 0 | 1 |
| No CC/MCC | 95 | 119 | 5 | 219 |
| All | 97 | 133 | 5 | 235 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_j_code_lines | 0.501 | -0.046 | 0.199 |
| avg_work_rvu | 0.461 | -0.035 | 0.095 |
| avg_n_distinct_rev_codes | 0.431 | 0.048 | 0.278 |
| avg_n_distinct_hcps | 0.419 | -0.236 | -0.072 |
| avg_relative_claim_charge | 0.366 | 0.039 | 0.141 |
| avg_organ_system_count | 0.126 | -0.042 | 0.134 |
| rate_or | 0.114 | -0.170 | 0.176 |
| avg_n_imaging_lines | 0.095 | 0.418 | 0.202 |
| rate_transfusion | 0.055 | 0.458 | -0.092 |
| rate_icu | 0.024 | 0.183 | -0.060 |
| rate_dialysis | 0.017 | 0.460 | 0.147 |
| avg_length_of_stay | -0.000 | nan | nan |
| rate_mechanical_ventilation | -0.000 | nan | nan |
| rate_multiple_or_days | -0.000 | nan | nan |
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 |
|---|---|---|---|---|---|---|
| H278 | Other specified disorders of lens | No CC/MCC | 9.555 | 3 | 1991 | work rvu (+3.10), n distinct hcps (+2.36), n distinct rev codes (+1.57) |
| H2189 | Other specified disorders of iris and ciliary body | No CC/MCC | 8.620 | 3 | 1519 | work rvu (+2.53), n distinct hcps (+2.05), n j code lines (+1.93) |
| H579 | Unspecified disorder of eye and adnexa | No CC/MCC | 8.033 | 3 | 1187 | work rvu (+2.78), n distinct hcps (+2.06), n j code lines (+1.86) |
| H21542 | Posterior synechiae (iris), left eye | No CC/MCC | 5.835 | 3 | 865 | relative claim charge (+2.20), n j code lines (+1.97), work rvu (+1.67) |
| H21541 | Posterior synechiae (iris), right eye | No CC/MCC | 4.487 | 3 | 909 | relative claim charge (+1.62), work rvu (+1.55), n j code lines (+1.41) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=97 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| F32A | Depression, unspecified | No CC/MCC | -0.336 | 21491 | n j code lines (-0.19), work rvu (-0.15), organ system count (+0.13) |
| E063 | Autoimmune thyroiditis | No CC/MCC | -0.336 | 1182 | relative claim charge (-0.36), n distinct hcps (+0.33), n distinct rev codes (-0.19) |
| H52222 | Regular astigmatism, left eye | No CC/MCC | -0.361 | 5684 | n distinct rev codes (-0.35), relative claim charge (+0.31), n distinct hcps (+0.30) |
| F411 | Generalized anxiety disorder | No CC/MCC | -0.371 | 2385 | work rvu (-0.25), n distinct hcps (-0.18), n distinct rev codes (-0.16) |
| N3281 | Overactive bladder | No CC/MCC | -0.374 | 760 | n j code lines (-0.44), n distinct hcps (+0.19), organ system count (+0.19) |
| M329 | Systemic lupus erythematosus, unspecified | No CC/MCC | -0.384 | 1104 | relative claim charge (-0.35), work rvu (-0.19), n j code lines (+0.13) |
| H52221 | Regular astigmatism, right eye | No CC/MCC | -0.398 | 5727 | n j code lines (-0.32), relative claim charge (+0.32), n distinct rev codes (-0.32) |
| I7300 | Raynaud's syndrome without gangrene | No CC/MCC | -0.400 | 803 | n distinct hcps (+0.71), relative claim charge (-0.51), n distinct rev codes (-0.32) |
| K2100 | Gastro-esophageal reflux disease with esophagitis, without bleeding | No CC/MCC | -0.419 | 904 | work rvu (-0.23), relative claim charge (-0.22), n distinct hcps (-0.19) |
| M3500 | Sjogren syndrome, unspecified | No CC/MCC | -0.423 | 823 | relative claim charge (-0.22), work rvu (-0.17), n distinct rev codes (-0.15) |
Tier 2 (n=133 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| H5789 | Other specified disorders of eye and adnexa | No CC/MCC | 3.431 | 1591 | n j code lines (+1.90), work rvu (+0.92), relative claim charge (+0.69) |
| H5704 | Mydriasis | No CC/MCC | 2.628 | 1263 | work rvu (+1.16), n j code lines (+0.82), relative claim charge (+0.71) |
| I132 | Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease | CC | 2.254 | 1367 | n distinct rev codes (+1.25), n j code lines (+0.53), relative claim charge (+0.21) |
| H52209 | Unspecified astigmatism, unspecified eye | No CC/MCC | 2.203 | 1748 | n j code lines (+1.85), n distinct hcps (+1.06), organ system count (-0.32) |
| N186 | End stage renal disease | MCC | 2.060 | 3813 | n distinct rev codes (+1.07), n j code lines (+0.42), relative claim charge (+0.28) |
| G309 | Alzheimer's disease, unspecified | No CC/MCC | 2.059 | 855 | relative claim charge (+0.86), n imaging lines (+0.61), n j code lines (+0.30) |
| D631 | Anemia in chronic kidney disease | No CC/MCC | 2.057 | 2459 | n distinct rev codes (+0.71), n j code lines (+0.43), organ system count (+0.26) |
| D696 | Thrombocytopenia, unspecified | No CC/MCC | 1.958 | 1594 | n distinct hcps (+0.63), transfusion (+0.59), n j code lines (+0.28) |
| M170 | Bilateral primary osteoarthritis of knee | No CC/MCC | 1.921 | 893 | work rvu (+0.52), relative claim charge (+0.47), n distinct hcps (+0.40) |
| H5700 | Unspecified anomaly of pupillary function | No CC/MCC | 1.920 | 2757 | relative claim charge (+1.13), work rvu (+1.03), n distinct hcps (+0.81) |
Tier 3 (n=5 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| H278 | Other specified disorders of lens | No CC/MCC | 9.555 | 1991 | work rvu (+3.10), n distinct hcps (+2.36), n distinct rev codes (+1.57) |
| H2189 | Other specified disorders of iris and ciliary body | No CC/MCC | 8.620 | 1519 | work rvu (+2.53), n distinct hcps (+2.05), n j code lines (+1.93) |
| H579 | Unspecified disorder of eye and adnexa | No CC/MCC | 8.033 | 1187 | work rvu (+2.78), n distinct hcps (+2.06), n j code lines (+1.86) |
| H21542 | Posterior synechiae (iris), left eye | No CC/MCC | 5.835 | 865 | relative claim charge (+2.20), n j code lines (+1.97), work rvu (+1.67) |
| H21541 | Posterior synechiae (iris), right eye | No CC/MCC | 4.487 | 909 | relative claim charge (+1.62), work rvu (+1.55), n j code lines (+1.41) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n j code lines | 144 | 61.300 |
| n distinct hcps | 135 | 57.400 |
| n distinct rev codes | 125 | 53.200 |
| relative claim charge | 120 | 51.100 |
| work rvu | 114 | 48.500 |
| organ system count | 41 | 17.400 |
| or | 10 | 4.300 |
| n imaging lines | 10 | 4.300 |
| transfusion | 5 | 2.100 |
| dialysis | 1 | 0.400 |
