OP - RA.0.mra

CM Codes

Data Overview

4545 total codes in komodo_rii; 18 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	14
CC	3
MCC	1

PCA Analysis

PC1 explains 37.6% of variance; PC1+PC2 together explain 59.4%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	work rvu	n distinct rev codes	n imaging lines	n j code lines	relative claim charge	organ system count	n distinct hcps	or
1	2.000	1700.000	3.226	2.003	1.630	0.100	0.904	1.445	0.729	0.006
2	10.000	14605.000	1.172	2.440	1.778	0.679	0.915	1.361	0.723	0.001
3	6.000	4144.000	2.400	3.137	2.584	0.905	1.144	1.311	0.776	0.001

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	1	1	1	3
MCC	0	0	1	1
No CC/MCC	1	9	4	14
All	2	10	6	18

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_imaging_lines	0.458	-0.426	0.484
avg_n_j_code_lines	0.457	-0.428	0.073
avg_n_distinct_rev_codes	0.453	-0.437	0.242
avg_relative_claim_charge	0.375	-0.447	0.448
avg_n_distinct_hcps	0.166	0.172	0.139
avg_work_rvu	0.107	-0.391	0.593
avg_length_of_stay	-0.000	nan	nan
rate_dialysis	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_icu	-0.022	0.304	-0.129
avg_organ_system_count	-0.133	-0.055	-0.193
rate_or	-0.251	0.290	-0.171
rate_transfusion	-0.339	0.094	0.189

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I517	Cardiomegaly	No CC/MCC	2.121	3	815	n imaging lines (+0.57), n distinct rev codes (+0.56), n j code lines (+0.48)
I480	Paroxysmal atrial fibrillation	No CC/MCC	1.821	3	580	n j code lines (+0.60), n distinct rev codes (+0.56), n distinct hcps (+0.42)
I739	Peripheral vascular disease, unspecified	No CC/MCC	1.765	3	609	relative claim charge (+0.94), n imaging lines (+0.60), n j code lines (+0.25)
I351	Nonrheumatic aortic (valve) insufficiency	No CC/MCC	1.188	3	1092	n imaging lines (+0.51), n distinct rev codes (+0.30), transfusion (+0.12)

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

None.

Top Codes by Tier

Tier 1 (n=2 codes)

code	Description	CMS severity	Score	N claims	Key drivers
C9000	Multiple myeloma not having achieved remission	CC	-2.595	1062	n j code lines (-1.08), transfusion (-0.95), n distinct rev codes (-0.52)
D472	Monoclonal gammopathy	No CC/MCC	-4.588	638	n j code lines (-1.02), transfusion (-0.97), n imaging lines (-0.82)

Tier 2 (n=10 codes)

code	Description	CMS severity	Score	N claims	Key drivers
Q231	Congenital insufficiency of aortic valve	CC	0.413	886	organ system count (+0.23), or (+0.15), n imaging lines (+0.15)
I7789	Other specified disorders of arteries and arterioles	No CC/MCC	0.137	532	n distinct rev codes (-0.16), or (+0.15), transfusion (+0.12)
I671	Cerebral aneurysm, nonruptured	No CC/MCC	-0.012	548	n imaging lines (-0.17), or (+0.15), relative claim charge (-0.13)
I10	Essential (primary) hypertension	No CC/MCC	-0.336	2321	n imaging lines (-0.25), n j code lines (+0.23), n distinct rev codes (+0.22)
I2510	Atherosclerotic heart disease of native coronary artery without angina pectoris	No CC/MCC	-0.489	631	or (-0.67), n distinct rev codes (+0.36), organ system count (-0.27)
I77810	Thoracic aortic ectasia	No CC/MCC	-0.579	2961	n distinct rev codes (-0.35), relative claim charge (-0.28), n imaging lines (-0.22)
I7120	Thoracic aortic aneurysm, without rupture, unspecified	No CC/MCC	-1.073	1463	n distinct rev codes (-0.45), n imaging lines (-0.44), relative claim charge (-0.34)
I77819	Aortic ectasia, unspecified site	No CC/MCC	-1.106	524	n distinct rev codes (-0.43), n imaging lines (-0.31), relative claim charge (-0.26)
I7121	Aneurysm of the ascending aorta, without rupture	No CC/MCC	-1.275	3722	n distinct rev codes (-0.46), relative claim charge (-0.44), n imaging lines (-0.42)
I701	Atherosclerosis of renal artery	No CC/MCC	-1.493	1017	n imaging lines (-0.68), n distinct rev codes (-0.40), relative claim charge (-0.34)

Tier 3 (n=6 codes)

code	Description	CMS severity	Score	N claims	Key drivers
Q213	Tetralogy of Fallot	MCC	3.989	520	n imaging lines (+0.87), n j code lines (+0.81), n distinct rev codes (+0.80)
I517	Cardiomegaly	No CC/MCC	2.121	815	n imaging lines (+0.57), n distinct rev codes (+0.56), n j code lines (+0.48)
G459	Transient cerebral ischemic attack, unspecified	CC	2.113	528	n distinct rev codes (+0.71), relative claim charge (+0.61), n imaging lines (+0.51)
I480	Paroxysmal atrial fibrillation	No CC/MCC	1.821	580	n j code lines (+0.60), n distinct rev codes (+0.56), n distinct hcps (+0.42)
I739	Peripheral vascular disease, unspecified	No CC/MCC	1.765	609	relative claim charge (+0.94), n imaging lines (+0.60), n j code lines (+0.25)
I351	Nonrheumatic aortic (valve) insufficiency	No CC/MCC	1.188	1092	n imaging lines (+0.51), n distinct rev codes (+0.30), transfusion (+0.12)

Key Driver Frequency

feature	count	pct
n imaging lines	14	77.800
n distinct rev codes	14	77.800
relative claim charge	8	44.400
n j code lines	7	38.900
or	4	22.200
transfusion	4	22.200
organ system count	2	11.100
n distinct hcps	1	5.600