OP - PU.0.bronchoscopy

CM Codes

Data Overview

7210 total codes in komodo_rii; 179 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	126
CC	48
MCC	5

PCA Analysis

PC1 explains 35.6% of variance; PC1+PC2 together explain 50.5%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n j code lines	organ system count	relative claim charge	n imaging lines	or	n distinct hcps
1	21.000	38511.000	7.623	7.804	4.453	2.716	0.782	0.044	0.670	0.750
2	40.000	81267.000	11.542	8.979	5.123	3.200	0.889	0.094	0.620	0.718
3	118.000	559083.000	15.863	9.819	5.837	4.079	1.073	0.186	0.619	0.732

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	8	15	25	48
MCC	0	3	2	5
No CC/MCC	13	22	91	126
All	21	40	118	179

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.461	0.184	-0.033
avg_n_distinct_rev_codes	0.433	0.121	-0.058
avg_n_imaging_lines	0.420	0.214	-0.050
avg_relative_claim_charge	0.411	0.107	-0.119
avg_n_j_code_lines	0.377	0.135	-0.129
avg_organ_system_count	0.279	0.042	-0.306
rate_transfusion	0.080	0.145	0.046
rate_dialysis	0.008	0.249	-0.028
avg_length_of_stay	0.000	nan	nan
rate_multiple_or_days	0.000	nan	nan
rate_mechanical_ventilation	-0.011	0.218	0.037
avg_n_distinct_hcps	-0.032	-0.102	-0.278
rate_or	-0.113	-0.015	-0.022
rate_icu	-0.123	0.257	-0.002

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
I700	Atherosclerosis of aorta	No CC/MCC	3.430	3	1004	n imaging lines (+1.14), n distinct rev codes (+0.79), relative claim charge (+0.58)
J431	Panlobular emphysema	No CC/MCC	3.264	3	578	n imaging lines (+1.01), work rvu (+0.62), n distinct rev codes (+0.58)
D3A090	Benign carcinoid tumor of the bronchus and lung	No CC/MCC	2.661	3	723	n imaging lines (+0.96), work rvu (+0.70), relative claim charge (+0.51)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	2.317	3	1129	n j code lines (+0.52), n imaging lines (+0.44), organ system count (+0.35)
D72820	Lymphocytosis (symptomatic)	No CC/MCC	2.282	3	539	n imaging lines (+1.46), n j code lines (-1.05), relative claim charge (+0.60)

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

None.

Top Codes by Tier

Tier 1 (n=21 codes)

code	Description	CMS severity	Score	N claims	Key drivers
T86818	Other complications of lung transplant	CC	-3.068	1872	n j code lines (-1.13), relative claim charge (-0.92), work rvu (-0.69)
D84821	Immunodeficiency due to drugs	No CC/MCC	-3.070	1057	n j code lines (-0.77), relative claim charge (-0.74), n imaging lines (-0.69)
J40	Bronchitis, not specified as acute or chronic	No CC/MCC	-3.113	2378	work rvu (-0.73), n j code lines (-0.69), relative claim charge (-0.63)
J9610	Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	CC	-3.137	972	n j code lines (-0.80), n distinct rev codes (-0.64), work rvu (-0.62)
F88	Other disorders of psychological development	No CC/MCC	-3.295	635	n distinct rev codes (-1.10), work rvu (-0.91), n imaging lines (-0.59)
Q318	Other congenital malformations of larynx	CC	-3.370	843	n imaging lines (-0.80), work rvu (-0.79), n distinct rev codes (-0.64)
A310	Pulmonary mycobacterial infection	CC	-3.464	1013	relative claim charge (-0.90), work rvu (-0.86), n j code lines (-0.77)
J353	Hypertrophy of tonsils with hypertrophy of adenoids	No CC/MCC	-3.503	645	n distinct rev codes (-1.25), work rvu (-0.81), n imaging lines (-0.70)
J479	Bronchiectasis, uncomplicated	No CC/MCC	-3.656	8392	relative claim charge (-0.88), work rvu (-0.87), n j code lines (-0.70)
J9819	Other pulmonary collapse	CC	-3.851	973	relative claim charge (-0.97), work rvu (-0.75), n imaging lines (-0.67)

Tier 2 (n=40 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9611	Chronic respiratory failure with hypoxia	CC	-0.264	3201	n j code lines (-0.22), relative claim charge (-0.12), n distinct rev codes (+0.08)
C3492	Malignant neoplasm of unspecified part of left bronchus or lung	CC	-0.458	1492	organ system count (-0.22), n imaging lines (-0.14), n distinct rev codes (-0.12)
J309	Allergic rhinitis, unspecified	No CC/MCC	-0.481	848	relative claim charge (-0.23), n j code lines (-0.17), work rvu (-0.16)
C969	Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified	CC	-0.520	2390	n imaging lines (-0.32), n distinct rev codes (-0.26), organ system count (-0.16)
C801	Malignant (primary) neoplasm, unspecified	No CC/MCC	-0.527	1139	n distinct rev codes (-0.29), organ system count (-0.21), n imaging lines (-0.19)
C3491	Malignant neoplasm of unspecified part of right bronchus or lung	CC	-0.687	2395	organ system count (-0.23), n distinct rev codes (-0.22), n imaging lines (-0.21)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-0.721	10785	n distinct rev codes (-0.20), relative claim charge (-0.20), work rvu (-0.17)
D860	Sarcoidosis of lung	No CC/MCC	-0.984	587	n imaging lines (-0.34), n distinct rev codes (-0.29), or (+0.18)
D869	Sarcoidosis, unspecified	No CC/MCC	-1.020	1155	n imaging lines (-0.56), n distinct rev codes (-0.23), organ system count (-0.20)
J181	Lobar pneumonia, unspecified organism	MCC	-1.045	649	organ system count (-0.30), n j code lines (-0.25), relative claim charge (-0.23)

Tier 3 (n=118 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I700	Atherosclerosis of aorta	No CC/MCC	3.430	1004	n imaging lines (+1.14), n distinct rev codes (+0.79), relative claim charge (+0.58)
J431	Panlobular emphysema	No CC/MCC	3.264	578	n imaging lines (+1.01), work rvu (+0.62), n distinct rev codes (+0.58)
J850	Gangrene and necrosis of lung	MCC	3.078	1291	work rvu (+0.89), relative claim charge (+0.80), n imaging lines (+0.73)
C3412	Malignant neoplasm of upper lobe, left bronchus or lung	CC	2.825	11565	work rvu (+0.81), n imaging lines (+0.69), relative claim charge (+0.68)
D3A090	Benign carcinoid tumor of the bronchus and lung	No CC/MCC	2.661	723	n imaging lines (+0.96), work rvu (+0.70), relative claim charge (+0.51)
C7801	Secondary malignant neoplasm of right lung	CC	2.575	1810	n imaging lines (+0.83), work rvu (+0.78), n j code lines (+0.49)
C342	Malignant neoplasm of middle lobe, bronchus or lung	CC	2.573	2660	work rvu (+0.80), relative claim charge (+0.66), n imaging lines (+0.56)
C3432	Malignant neoplasm of lower lobe, left bronchus or lung	CC	2.526	6189	work rvu (+0.77), relative claim charge (+0.59), n imaging lines (+0.59)
C3411	Malignant neoplasm of upper lobe, right bronchus or lung	CC	2.517	13658	work rvu (+0.77), relative claim charge (+0.61), n imaging lines (+0.61)
C3431	Malignant neoplasm of lower lobe, right bronchus or lung	CC	2.437	7984	work rvu (+0.75), relative claim charge (+0.59), n imaging lines (+0.56)

Key Driver Frequency

feature	count	pct
work rvu	106	59.200
n distinct rev codes	98	54.700
n imaging lines	92	51.400
relative claim charge	84	46.900
organ system count	75	41.900
n j code lines	66	36.900
icu	10	5.600
or	5	2.800
transfusion	1	0.600