OP - RA.0.mri
CM Codes
Data Overview
32510 total codes in komodo_rii; 308 retained after n_claims > 500 filter.
| CMS severity | n codes |
|---|---|
| No CC/MCC | 265 |
| CC | 38 |
| MCC | 5 |
PCA Analysis
PC1 explains 42.5% of variance; PC1+PC2 together explain 59.0%.
Tier Clustering (k=4)
Tier Summary
| tier | n_codes | n_claims | n distinct rev codes | work rvu | organ system count | n j code lines | n imaging lines | relative claim charge | n distinct hcps | or |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 128.000 | 7493297.000 | 1.296 | 2.021 | 1.483 | 0.135 | 1.216 | 0.850 | 0.716 | 0.014 |
| 2 | 108.000 | 4105435.000 | 1.995 | 2.777 | 1.540 | 0.532 | 1.377 | 1.096 | 0.716 | 0.004 |
| 3 | 57.000 | 1541543.000 | 2.572 | 3.623 | 1.786 | 0.727 | 1.678 | 1.279 | 0.728 | 0.003 |
| 4 | 15.000 | 376970.000 | 3.816 | 4.308 | 3.098 | 1.273 | 1.676 | 1.366 | 0.627 | 0.007 |
CMS Severity × intensity Tier
| cms_severity | Tier 1 | Tier 2 | Tier 3 | Tier 4 | All |
|---|---|---|---|---|---|
| CC | 0 | 10 | 27 | 1 | 38 |
| MCC | 0 | 1 | 4 | 0 | 5 |
| No CC/MCC | 128 | 97 | 26 | 14 | 265 |
| All | 128 | 108 | 57 | 15 | 308 |
Feature Analysis
Feature Correlation
Feature Audit
| pc1_loading | r_with_volume | r_with_severity | |
|---|---|---|---|
| avg_n_distinct_rev_codes | 0.405 | -0.185 | 0.409 |
| avg_work_rvu | 0.389 | -0.110 | 0.424 |
| avg_n_j_code_lines | 0.375 | -0.167 | 0.385 |
| avg_relative_claim_charge | 0.353 | -0.163 | 0.347 |
| rate_icu | 0.305 | 0.022 | 0.114 |
| avg_organ_system_count | 0.304 | -0.099 | 0.092 |
| avg_n_imaging_lines | 0.286 | -0.038 | 0.378 |
| rate_transfusion | 0.280 | 0.031 | 0.130 |
| rate_dialysis | 0.211 | 0.093 | 0.125 |
| rate_mechanical_ventilation | 0.074 | 0.007 | 0.073 |
| avg_length_of_stay | -0.000 | nan | nan |
| rate_multiple_or_days | -0.000 | nan | nan |
| rate_or | -0.066 | -0.135 | -0.079 |
| avg_n_distinct_hcps | -0.138 | -0.050 | 0.191 |
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 |
|---|---|---|---|---|---|---|
| D649 | Anemia, unspecified | No CC/MCC | 9.121 | 4 | 13065 | transfusion (+3.61), n distinct rev codes (+1.07), icu (+1.00) |
| K219 | Gastro-esophageal reflux disease without esophagitis | No CC/MCC | 8.873 | 4 | 24424 | icu (+1.55), organ system count (+1.38), n distinct rev codes (+1.28) |
| E785 | Hyperlipidemia, unspecified | No CC/MCC | 8.268 | 4 | 39831 | icu (+1.70), n distinct rev codes (+1.32), organ system count (+1.25) |
| J449 | Chronic obstructive pulmonary disease, unspecified | No CC/MCC | 7.946 | 4 | 10703 | organ system count (+1.57), icu (+1.45), n distinct rev codes (+1.33) |
| G4733 | Obstructive sleep apnea (adult) (pediatric) | No CC/MCC | 7.783 | 4 | 12305 | dialysis (+1.41), n distinct rev codes (+1.18), organ system count (+1.17) |
Under-tiered: Tier 1, MCC (0 codes)
None.
Top Codes by Tier
Tier 1 (n=128 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| M533 | Sacrococcygeal disorders, not elsewhere classified | No CC/MCC | -0.900 | 31623 | n j code lines (-0.21), n distinct rev codes (-0.17), relative claim charge (-0.13) |
| M7989 | Other specified soft tissue disorders | No CC/MCC | -0.902 | 41871 | relative claim charge (-0.18), n imaging lines (-0.16), work rvu (-0.13) |
| G8929 | Other chronic pain | No CC/MCC | -0.914 | 463570 | organ system count (+0.33), n distinct rev codes (-0.27), relative claim charge (-0.27) |
| M5450 | Low back pain, unspecified | No CC/MCC | -0.993 | 340941 | n distinct rev codes (-0.26), n j code lines (-0.26), work rvu (-0.13) |
| D0512 | Intraductal carcinoma in situ of left breast | No CC/MCC | -0.994 | 10655 | work rvu (-0.59), n j code lines (+0.31), organ system count (-0.26) |
| M170 | Bilateral primary osteoarthritis of knee | No CC/MCC | -0.995 | 11895 | n j code lines (-0.38), n distinct rev codes (-0.31), work rvu (-0.19) |
| M51369 | Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain | No CC/MCC | -1.016 | 34307 | n distinct rev codes (-0.31), n j code lines (-0.27), organ system count (-0.17) |
| M5440 | Lumbago with sciatica, unspecified side | No CC/MCC | -1.022 | 17221 | n distinct rev codes (-0.28), n j code lines (-0.26), work rvu (-0.13) |
| M5011 | Cervical disc disorder with radiculopathy, high cervical region | No CC/MCC | -1.023 | 13585 | n j code lines (-0.34), n distinct rev codes (-0.34), organ system count (-0.24) |
| M461 | Sacroiliitis, not elsewhere classified | No CC/MCC | -1.044 | 19882 | n j code lines (-0.24), n distinct rev codes (-0.19), organ system count (-0.15) |
Tier 2 (n=108 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| C50919 | Malignant neoplasm of unspecified site of unspecified female breast | No CC/MCC | 1.023 | 41596 | n j code lines (+0.39), work rvu (+0.33), n distinct rev codes (+0.28) |
| M5134 | Other intervertebral disc degeneration, thoracic region | No CC/MCC | 1.009 | 33483 | relative claim charge (+0.63), n imaging lines (+0.61), work rvu (+0.45) |
| Q283 | Other malformations of cerebral vessels | MCC | 0.978 | 13299 | dialysis (+1.07), organ system count (-0.59), n j code lines (+0.29) |
| K8020 | Calculus of gallbladder without cholecystitis without obstruction | No CC/MCC | 0.926 | 36742 | n j code lines (+0.27), organ system count (+0.21), n distinct rev codes (+0.20) |
| M4804 | Spinal stenosis, thoracic region | No CC/MCC | 0.905 | 38490 | relative claim charge (+0.58), n imaging lines (+0.56), work rvu (+0.40) |
| I517 | Cardiomegaly | No CC/MCC | 0.889 | 27422 | n j code lines (+0.38), n distinct rev codes (+0.38), n imaging lines (+0.16) |
| J3489 | Other specified disorders of nose and nasal sinuses | No CC/MCC | 0.887 | 34769 | organ system count (+0.37), relative claim charge (+0.19), n j code lines (+0.17) |
| G9389 | Other specified disorders of brain | No CC/MCC | 0.874 | 118887 | work rvu (+0.22), n distinct rev codes (+0.22), n j code lines (+0.21) |
| M810 | Age-related osteoporosis without current pathological fracture | No CC/MCC | 0.866 | 15411 | organ system count (+0.35), n distinct rev codes (+0.35), work rvu (+0.17) |
| K7460 | Unspecified cirrhosis of liver | No CC/MCC | 0.773 | 48489 | n distinct rev codes (+0.40), n j code lines (+0.36), dialysis (+0.26) |
Tier 3 (n=57 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| E559 | Vitamin D deficiency, unspecified | No CC/MCC | 4.288 | 17947 | n distinct rev codes (+0.82), organ system count (+0.82), dialysis (+0.61) |
| C7951 | Secondary malignant neoplasm of bone | CC | 4.046 | 62667 | work rvu (+1.18), relative claim charge (+0.92), n imaging lines (+0.86) |
| K5900 | Constipation, unspecified | No CC/MCC | 3.879 | 11117 | transfusion (+0.94), n distinct rev codes (+0.61), n j code lines (+0.59) |
| I6523 | Occlusion and stenosis of bilateral carotid arteries | No CC/MCC | 3.837 | 12231 | dialysis (+0.87), relative claim charge (+0.55), n distinct rev codes (+0.45) |
| J90 | Pleural effusion, not elsewhere classified | CC | 3.712 | 13785 | organ system count (+0.79), work rvu (+0.59), n distinct rev codes (+0.57) |
| E782 | Mixed hyperlipidemia | No CC/MCC | 3.536 | 12085 | organ system count (+1.00), n distinct rev codes (+0.91), icu (+0.63) |
| G950 | Syringomyelia and syringobulbia | CC | 3.443 | 17096 | n imaging lines (+1.08), relative claim charge (+1.02), work rvu (+1.01) |
| G379 | Demyelinating disease of central nervous system, unspecified | CC | 3.185 | 26136 | relative claim charge (+1.26), work rvu (+1.08), n imaging lines (+0.71) |
| C499 | Malignant neoplasm of connective and soft tissue, unspecified | CC | 3.118 | 21359 | work rvu (+0.84), n imaging lines (+0.73), n distinct rev codes (+0.64) |
| G35 | None | No CC/MCC | 2.957 | 152784 | relative claim charge (+1.11), work rvu (+1.04), n imaging lines (+0.75) |
Tier 4 (n=15 codes)
| code | Description | CMS severity | Score | N claims | Key drivers |
|---|---|---|---|---|---|
| D649 | Anemia, unspecified | No CC/MCC | 9.121 | 13065 | transfusion (+3.61), n distinct rev codes (+1.07), icu (+1.00) |
| K219 | Gastro-esophageal reflux disease without esophagitis | No CC/MCC | 8.873 | 24424 | icu (+1.55), organ system count (+1.38), n distinct rev codes (+1.28) |
| E785 | Hyperlipidemia, unspecified | No CC/MCC | 8.268 | 39831 | icu (+1.70), n distinct rev codes (+1.32), organ system count (+1.25) |
| J449 | Chronic obstructive pulmonary disease, unspecified | No CC/MCC | 7.946 | 10703 | organ system count (+1.57), icu (+1.45), n distinct rev codes (+1.33) |
| G4733 | Obstructive sleep apnea (adult) (pediatric) | No CC/MCC | 7.783 | 12305 | dialysis (+1.41), n distinct rev codes (+1.18), organ system count (+1.17) |
| F17210 | Nicotine dependence, cigarettes, uncomplicated | No CC/MCC | 7.780 | 15783 | icu (+2.39), organ system count (+1.08), work rvu (+1.00) |
| F419 | Anxiety disorder, unspecified | No CC/MCC | 7.283 | 17102 | icu (+1.74), organ system count (+1.15), n distinct rev codes (+1.11) |
| J45909 | Unspecified asthma, uncomplicated | No CC/MCC | 7.051 | 11265 | transfusion (+1.55), n j code lines (+1.36), organ system count (+1.24) |
| E669 | Obesity, unspecified | No CC/MCC | 6.829 | 13211 | icu (+1.95), n j code lines (+1.16), organ system count (+1.10) |
| E039 | Hypothyroidism, unspecified | No CC/MCC | 6.296 | 25561 | n distinct rev codes (+1.18), organ system count (+1.03), icu (+0.86) |
Key Driver Frequency
| feature | count | pct |
|---|---|---|
| n distinct rev codes | 211 | 68.500 |
| n j code lines | 179 | 58.100 |
| work rvu | 152 | 49.400 |
| relative claim charge | 130 | 42.200 |
| organ system count | 92 | 29.900 |
| n imaging lines | 86 | 27.900 |
| transfusion | 17 | 5.500 |
| icu | 17 | 5.500 |
| dialysis | 15 | 4.900 |
| n distinct hcps | 15 | 4.900 |
| mechanical ventilation | 6 | 1.900 |
| or | 4 | 1.300 |
