OP - RA.0.mpi

CM Codes

Data Overview

8916 total codes in komodo_rii; 155 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	119
CC	30
MCC	6

PCA Analysis

PC1 explains 61.1% of variance; PC1+PC2 together explain 72.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	organ system count	work rvu	n j code lines	relative claim charge	n distinct hcps	n imaging lines	dialysis
1	89.000	1788543.000	4.411	1.696	2.302	1.139	1.034	0.666	0.021	0.000
2	38.000	219610.000	5.275	2.441	2.769	1.322	1.116	0.602	0.052	0.001
3	20.000	118331.000	6.429	3.348	3.147	1.630	1.202	0.492	0.129	0.003
4	8.000	23274.000	8.056	3.643	3.722	2.172	1.443	0.309	0.141	0.002

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	23	3	2	2	30
MCC	4	1	1	0	6
No CC/MCC	62	34	17	6	119
All	89	38	20	8	155

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.377	-0.246	-0.205
avg_n_j_code_lines	0.354	-0.187	0.006
avg_relative_claim_charge	0.343	-0.198	-0.295
avg_work_rvu	0.331	-0.226	-0.329
avg_organ_system_count	0.328	-0.240	-0.234
avg_n_imaging_lines	0.318	-0.288	-0.205
rate_icu	0.246	-0.054	0.006
rate_transfusion	0.241	0.156	0.023
rate_or	0.212	0.049	-0.072
rate_dialysis	0.142	0.227	0.162
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
avg_n_distinct_hcps	-0.336	0.187	0.036

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E876	Hypokalemia	No CC/MCC	8.154	4	3697	relative claim charge (+1.32), n j code lines (+1.25), n distinct rev codes (+1.24)
I160	Hypertensive urgency	No CC/MCC	7.512	4	3038	relative claim charge (+1.35), n j code lines (+1.18), n distinct hcps (+1.15)
E8342	Hypomagnesemia	No CC/MCC	7.270	4	1618	n j code lines (+1.62), n distinct rev codes (+1.19), n distinct hcps (+0.93)
D649	Anemia, unspecified	No CC/MCC	6.543	4	3658	transfusion (+1.97), n distinct rev codes (+0.77), organ system count (+0.66)
F32A	Depression, unspecified	No CC/MCC	6.106	4	3961	n distinct rev codes (+0.88), n j code lines (+0.86), relative claim charge (+0.85)

Under-tiered: Tier 1, MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I219	Acute myocardial infarction, unspecified	MCC	-2.405	1	2946	work rvu (-0.37), n distinct rev codes (-0.34), relative claim charge (-0.31)
I5021	Acute systolic (congestive) heart failure	MCC	-2.094	1	1630	work rvu (-0.44), relative claim charge (-0.39), organ system count (-0.32)
I639	Cerebral infarction, unspecified	MCC	-1.887	1	3800	n distinct hcps (-0.29), work rvu (-0.28), n distinct rev codes (-0.27)
I214	Non-ST elevation (NSTEMI) myocardial infarction	MCC	-1.568	1	5973	work rvu (-0.33), relative claim charge (-0.26), organ system count (-0.24)

Top Codes by Tier

Tier 1 (n=89 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E781	Pure hyperglyceridemia	No CC/MCC	-0.745	1720	icu (+0.29), n j code lines (-0.29), or (-0.18)
I358	Other nonrheumatic aortic valve disorders	No CC/MCC	-0.757	5798	organ system count (-0.26), work rvu (+0.24), relative claim charge (+0.21)
I25110	Atherosclerotic heart disease of native coronary artery with unstable angina pectoris	CC	-0.764	6265	n distinct hcps (+0.28), relative claim charge (-0.25), organ system count (-0.17)
I700	Atherosclerosis of aorta	No CC/MCC	-0.793	8696	n imaging lines (+0.20), n distinct rev codes (-0.15), n j code lines (-0.14)
I371	Nonrheumatic pulmonary valve insufficiency	No CC/MCC	-0.794	5211	n distinct hcps (-0.46), work rvu (+0.37), relative claim charge (+0.25)
I6521	Occlusion and stenosis of right carotid artery	No CC/MCC	-0.812	1627	n distinct hcps (-0.31), organ system count (-0.19), n imaging lines (+0.15)
I7140	Abdominal aortic aneurysm, without rupture, unspecified	No CC/MCC	-0.816	2999	n imaging lines (+0.17), n distinct hcps (-0.17), organ system count (-0.15)
I6523	Occlusion and stenosis of bilateral carotid arteries	No CC/MCC	-0.828	13148	n distinct hcps (-0.30), work rvu (+0.17), n j code lines (-0.16)
I509	Heart failure, unspecified	No CC/MCC	-0.835	17546	work rvu (-0.20), relative claim charge (-0.16), n imaging lines (-0.15)
I77810	Thoracic aortic ectasia	No CC/MCC	-0.875	8024	n distinct hcps (-0.33), n j code lines (-0.25), organ system count (-0.24)

Tier 2 (n=38 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N182	Chronic kidney disease, stage 2 (mild)	No CC/MCC	2.007	1464	organ system count (+0.55), n distinct rev codes (+0.39), n j code lines (+0.32)
N1832	Chronic kidney disease, stage 3b	No CC/MCC	2.002	2526	organ system count (+0.50), transfusion (+0.45), n distinct rev codes (+0.37)
N1831	Chronic kidney disease, stage 3a	No CC/MCC	1.850	3610	organ system count (+0.52), transfusion (+0.41), n distinct rev codes (+0.32)
E1165	Type 2 diabetes mellitus with hyperglycemia	No CC/MCC	1.795	7416	n distinct rev codes (+0.35), n j code lines (+0.33), n distinct hcps (+0.30)
E1151	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	No CC/MCC	1.679	2608	n j code lines (+0.37), organ system count (+0.30), n distinct rev codes (+0.29)
J449	Chronic obstructive pulmonary disease, unspecified	No CC/MCC	1.460	17639	organ system count (+0.46), n distinct hcps (+0.26), n j code lines (+0.26)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	1.406	5941	organ system count (+0.54), work rvu (+0.25), relative claim charge (+0.22)
M79602	Pain in left arm	No CC/MCC	1.202	2640	work rvu (+0.27), n imaging lines (+0.24), n distinct hcps (+0.23)
I959	Hypotension, unspecified	No CC/MCC	1.178	2429	icu (+0.75), dialysis (+0.29), n j code lines (+0.22)
J984	Other disorders of lung	No CC/MCC	1.124	1431	n imaging lines (+0.81), or (+0.32), organ system count (+0.31)

Tier 3 (n=20 codes)

code	Description	CMS severity	Score	N claims	Key drivers
F419	Anxiety disorder, unspecified	No CC/MCC	5.311	6708	n distinct rev codes (+0.80), work rvu (+0.72), organ system count (+0.71)
I130	Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease	CC	4.944	3946	n distinct hcps (+0.85), n j code lines (+0.83), n distinct rev codes (+0.81)
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	4.673	2949	dialysis (+1.29), or (+0.99), n imaging lines (+0.96)
M549	Dorsalgia, unspecified	No CC/MCC	4.616	2083	n imaging lines (+0.73), relative claim charge (+0.64), work rvu (+0.62)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	4.198	19581	organ system count (+0.70), n distinct rev codes (+0.66), n distinct hcps (+0.56)
M542	Cervicalgia	No CC/MCC	4.169	1657	n imaging lines (+1.06), work rvu (+0.57), n distinct rev codes (+0.51)
K449	Diaphragmatic hernia without obstruction or gangrene	No CC/MCC	4.118	2158	n imaging lines (+1.14), or (+0.64), n distinct rev codes (+0.41)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	4.019	10543	dialysis (+0.63), organ system count (+0.56), transfusion (+0.50)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	3.604	1556	n imaging lines (+1.11), work rvu (+0.55), organ system count (+0.43)
E1140	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	No CC/MCC	3.537	2148	n distinct hcps (+0.63), n distinct rev codes (+0.61), n j code lines (+0.57)

Tier 4 (n=8 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N179	Acute kidney failure, unspecified	CC	9.363	3212	relative claim charge (+1.45), n distinct hcps (+1.29), n distinct rev codes (+1.23)
E876	Hypokalemia	No CC/MCC	8.154	3697	relative claim charge (+1.32), n j code lines (+1.25), n distinct rev codes (+1.24)
E871	Hypo-osmolality and hyponatremia	CC	7.777	1616	n distinct rev codes (+1.19), n j code lines (+1.18), n distinct hcps (+1.02)
I160	Hypertensive urgency	No CC/MCC	7.512	3038	relative claim charge (+1.35), n j code lines (+1.18), n distinct hcps (+1.15)
E8342	Hypomagnesemia	No CC/MCC	7.270	1618	n j code lines (+1.62), n distinct rev codes (+1.19), n distinct hcps (+0.93)
D649	Anemia, unspecified	No CC/MCC	6.543	3658	transfusion (+1.97), n distinct rev codes (+0.77), organ system count (+0.66)
F32A	Depression, unspecified	No CC/MCC	6.106	3961	n distinct rev codes (+0.88), n j code lines (+0.86), relative claim charge (+0.85)
N400	Benign prostatic hyperplasia without lower urinary tract symptoms	No CC/MCC	6.084	2474	relative claim charge (+1.10), n distinct rev codes (+0.98), n imaging lines (+0.79)

Key Driver Frequency

feature	count	pct
organ system count	82	52.900
n distinct rev codes	79	51.000
work rvu	74	47.700
relative claim charge	53	34.200
n j code lines	52	33.500
n distinct hcps	51	32.900
n imaging lines	29	18.700
or	20	12.900
icu	14	9.000
transfusion	7	4.500
dialysis	4	2.600