OP - RA.0.CT

CM Codes

Data Overview

20377 total codes in komodo_rii; 270 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	176
CC	87
MCC	7

PCA Analysis

PC1 explains 40.4% of variance; PC1+PC2 together explain 56.3%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n j code lines	organ system count	n imaging lines	n distinct hcps	relative claim charge	or
1	181.000	5004945.000	3.076	2.844	0.755	2.127	1.626	0.706	1.065	0.001
2	53.000	1605407.000	3.864	3.671	1.365	2.433	1.102	0.546	1.107	0.002
3	36.000	665771.000	4.770	4.447	2.021	3.105	1.021	0.458	1.251	0.004

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	74	10	3	87
MCC	3	2	2	7
No CC/MCC	104	41	31	176
All	181	53	36	270

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_j_code_lines	0.393	0.022	0.050
avg_n_distinct_rev_codes	0.383	-0.100	0.040
avg_work_rvu	0.366	-0.048	0.024
rate_icu	0.339	0.118	-0.163
rate_transfusion	0.250	0.015	-0.123
rate_or	0.242	-0.126	0.027
rate_mechanical_ventilation	0.237	0.214	-0.142
avg_organ_system_count	0.202	-0.020	-0.529
avg_relative_claim_charge	0.198	-0.107	0.112
rate_dialysis	0.117	0.170	-0.254
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_n_imaging_lines	-0.208	-0.065	0.277
avg_n_distinct_hcps	-0.369	-0.047	0.249

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	7.350	3	7999	icu (+1.91), mechanical ventilation (+1.65), n j code lines (+0.90)
I110	Hypertensive heart disease with heart failure	No CC/MCC	5.811	3	9221	n distinct rev codes (+1.07), icu (+0.88), n distinct hcps (+0.79)
F319	Bipolar disorder, unspecified	No CC/MCC	5.784	3	5818	icu (+1.22), n distinct rev codes (+0.96), n j code lines (+0.88)
E876	Hypokalemia	No CC/MCC	5.752	3	27234	n j code lines (+0.98), n distinct hcps (+0.83), icu (+0.75)
S0990XA	Unspecified injury of head, initial encounter	No CC/MCC	5.636	3	9351	work rvu (+1.85), relative claim charge (+1.42), n distinct hcps (+0.75)

Under-tiered: Tier 1, MCC (3 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I81	Portal vein thrombosis	MCC	-1.011	1	5670	n distinct hcps (-0.33), work rvu (-0.25), icu (-0.16)
K651	Peritoneal abscess	MCC	-0.474	1	11197	mechanical ventilation (+1.01), work rvu (-0.53), n distinct rev codes (-0.43)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	-0.328	1	9449	n distinct hcps (-0.28), n imaging lines (-0.18), organ system count (+0.14)

Top Codes by Tier

Tier 1 (n=181 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D259	Leiomyoma of uterus, unspecified	No CC/MCC	-0.055	35409	transfusion (+0.32), n imaging lines (+0.17), n distinct rev codes (-0.15)
K766	Portal hypertension	CC	-0.055	8101	transfusion (+0.31), icu (+0.22), work rvu (-0.21)
K5732	Diverticulitis of large intestine without perforation or abscess without bleeding	CC	-0.134	56162	n distinct hcps (+0.37), n imaging lines (+0.29), relative claim charge (-0.19)
N433	Hydrocele, unspecified	No CC/MCC	-0.262	7807	n imaging lines (+0.18), icu (-0.16), n distinct hcps (+0.11)
N1832	Chronic kidney disease, stage 3b	No CC/MCC	-0.297	5847	n j code lines (-0.30), work rvu (-0.27), transfusion (+0.26)
I2699	Other pulmonary embolism without acute cor pulmonale	MCC	-0.328	9449	n distinct hcps (-0.28), n imaging lines (-0.18), organ system count (+0.14)
K6289	Other specified diseases of anus and rectum	No CC/MCC	-0.372	18630	icu (-0.16), n imaging lines (+0.13), organ system count (-0.11)
M48061	Spinal stenosis, lumbar region without neurogenic claudication	No CC/MCC	-0.395	7589	n distinct rev codes (-0.19), organ system count (+0.18), transfusion (-0.15)
E041	Nontoxic single thyroid nodule	No CC/MCC	-0.420	15190	n distinct hcps (-0.33), n imaging lines (-0.26), organ system count (+0.23)
C771	Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes	CC	-0.431	7899	n imaging lines (-0.29), n distinct hcps (-0.25), relative claim charge (+0.19)

Tier 2 (n=53 codes)

code	Description	CMS severity	Score	N claims	Key drivers
S301XXA	None	No CC/MCC	2.808	11011	work rvu (+0.79), n distinct hcps (+0.58), mechanical ventilation (+0.55)
A084	Viral intestinal infection, unspecified	No CC/MCC	2.743	5857	n distinct hcps (+0.86), n j code lines (+0.79), work rvu (+0.50)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	2.716	24540	n distinct rev codes (+0.65), organ system count (+0.43), n distinct hcps (+0.39)
I10	Essential (primary) hypertension	No CC/MCC	2.618	224673	n distinct rev codes (+0.63), n distinct hcps (+0.46), n j code lines (+0.41)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	2.452	90612	n distinct rev codes (+0.78), n j code lines (+0.44), n distinct hcps (+0.36)
K2970	Gastritis, unspecified, without bleeding	No CC/MCC	2.410	14200	n distinct rev codes (+0.70), n j code lines (+0.62), n distinct hcps (+0.47)
N12	Tubulo-interstitial nephritis, not specified as acute or chronic	CC	2.366	17813	n j code lines (+0.93), n distinct hcps (+0.69), n imaging lines (+0.35)
N10	Acute pyelonephritis	CC	2.268	7609	n j code lines (+0.98), n distinct hcps (+0.58), n distinct rev codes (+0.52)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	2.252	76463	n distinct hcps (+0.41), n distinct rev codes (+0.35), n j code lines (+0.33)
E039	Hypothyroidism, unspecified	No CC/MCC	2.213	38010	n distinct rev codes (+0.64), work rvu (+0.28), organ system count (+0.26)

Tier 3 (n=36 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K3580	Unspecified acute appendicitis	CC	12.067	6540	n j code lines (+3.71), or (+3.59), work rvu (+2.89)
E8342	Hypomagnesemia	No CC/MCC	7.350	7999	icu (+1.91), mechanical ventilation (+1.65), n j code lines (+0.90)
N179	Acute kidney failure, unspecified	CC	7.036	14454	icu (+2.59), mechanical ventilation (+1.31), n distinct hcps (+0.81)
E871	Hypo-osmolality and hyponatremia	CC	6.645	10517	icu (+1.79), n distinct rev codes (+0.93), n j code lines (+0.67)
I110	Hypertensive heart disease with heart failure	No CC/MCC	5.811	9221	n distinct rev codes (+1.07), icu (+0.88), n distinct hcps (+0.79)
F319	Bipolar disorder, unspecified	No CC/MCC	5.784	5818	icu (+1.22), n distinct rev codes (+0.96), n j code lines (+0.88)
E876	Hypokalemia	No CC/MCC	5.752	27234	n j code lines (+0.98), n distinct hcps (+0.83), icu (+0.75)
S0990XA	Unspecified injury of head, initial encounter	No CC/MCC	5.636	9351	work rvu (+1.85), relative claim charge (+1.42), n distinct hcps (+0.75)
G4733	Obstructive sleep apnea (adult) (pediatric)	No CC/MCC	5.434	8249	icu (+1.06), mechanical ventilation (+0.75), organ system count (+0.59)
I480	Paroxysmal atrial fibrillation	No CC/MCC	5.035	5743	icu (+1.31), mechanical ventilation (+1.09), n distinct rev codes (+0.73)

Key Driver Frequency

feature	count	pct
n distinct hcps	156	57.800
n distinct rev codes	139	51.500
n j code lines	127	47.000
work rvu	105	38.900
n imaging lines	87	32.200
organ system count	79	29.300
icu	43	15.900
relative claim charge	41	15.200
mechanical ventilation	14	5.200
transfusion	13	4.800
or	4	1.500
dialysis	2	0.700