OP - RE.0.ovarian_surgery

CM Codes

Data Overview

5209 total codes in komodo_rii; 137 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	134
CC	2
MCC	1

PCA Analysis

PC1 explains 34.5% of variance; PC1+PC2 together explain 62.5%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	work rvu	organ system count	n j code lines	n distinct rev codes	relative claim charge	or	n distinct hcps	n imaging lines
1	52.000	188063.000	16.741	3.648	9.767	8.211	1.023	0.854	0.728	0.017
2	39.000	223939.000	18.840	2.627	10.062	8.085	1.110	0.809	0.708	0.015
3	32.000	79815.000	20.422	2.311	10.515	7.776	1.182	0.772	0.688	0.003
4	14.000	17876.000	23.800	2.508	10.958	7.584	1.289	0.699	0.622	0.002

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	1	1	0	0	2
MCC	1	0	0	0	1
No CC/MCC	50	38	32	14	134
All	52	39	32	14	137

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_work_rvu	0.458	-0.135	0.109
avg_relative_claim_charge	0.428	-0.101	0.148
avg_n_j_code_lines	0.357	-0.149	0.216
rate_dialysis	0.103	0.185	-0.052
avg_length_of_stay	-0.000	nan	nan
rate_mechanical_ventilation	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_icu	-0.039	0.147	0.281
rate_transfusion	-0.046	0.064	0.117
avg_n_imaging_lines	-0.061	0.188	0.254
avg_n_distinct_rev_codes	-0.203	-0.054	0.254
avg_n_distinct_hcps	-0.298	-0.070	0.208
avg_organ_system_count	-0.358	-0.062	-0.092
rate_or	-0.451	-0.087	-0.011

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
D251	Intramural leiomyoma of uterus	No CC/MCC	5.906	4	2400	or (+1.62), work rvu (+1.44), relative claim charge (+0.97)
N8003	Adenomyosis of the uterus	No CC/MCC	4.912	4	2618	or (+1.45), work rvu (+1.01), n distinct hcps (+0.90)
N72	Inflammatory disease of cervix uteri	No CC/MCC	4.798	4	1058	or (+1.81), n distinct hcps (+1.23), work rvu (+1.10)
N393	Stress incontinence (female) (male)	No CC/MCC	4.244	4	840	work rvu (+2.05), relative claim charge (+0.80), n distinct hcps (+0.57)
N888	Other specified noninflammatory disorders of cervix uteri	No CC/MCC	4.230	4	843	or (+1.36), n distinct hcps (+1.04), work rvu (+0.91)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
K661	Hemoperitoneum	MCC	-1.396	1	969	n distinct rev codes (-1.16), n j code lines (+0.52), transfusion (-0.51)

Top Codes by Tier

Tier 1 (n=52 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N83512	Torsion of left ovary and ovarian pedicle	CC	-1.023	1210	n distinct rev codes (-1.02), n distinct hcps (-0.41), n j code lines (+0.40)
K5900	Constipation, unspecified	No CC/MCC	-1.108	1034	n distinct hcps (-0.35), or (-0.34), organ system count (-0.24)
E663	Overweight	No CC/MCC	-1.164	513	work rvu (-0.53), relative claim charge (-0.48), n j code lines (-0.19)
D279	Benign neoplasm of unspecified ovary	No CC/MCC	-1.342	538	or (-0.44), work rvu (-0.36), n distinct hcps (-0.21)
D282	Benign neoplasm of uterine tubes and ligaments	No CC/MCC	-1.392	2467	n distinct hcps (-1.62), n j code lines (+0.99), or (-0.78)
K661	Hemoperitoneum	MCC	-1.396	969	n distinct rev codes (-1.16), n j code lines (+0.52), transfusion (-0.51)
E119	Type 2 diabetes mellitus without complications	No CC/MCC	-1.500	6031	work rvu (-0.39), organ system count (-0.34), or (-0.31)
T8332XA	Displacement of intrauterine contraceptive device, initial encounter	No CC/MCC	-1.546	886	relative claim charge (-0.54), work rvu (-0.42), n j code lines (-0.38)
E039	Hypothyroidism, unspecified	No CC/MCC	-1.568	7336	work rvu (-0.35), relative claim charge (-0.34), or (-0.27)
D509	Iron deficiency anemia, unspecified	No CC/MCC	-1.611	1101	or (-0.37), organ system count (-0.35), n j code lines (-0.30)

Tier 2 (n=39 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N939	Abnormal uterine and vaginal bleeding, unspecified	No CC/MCC	0.752	7350	organ system count (+0.25), n j code lines (-0.25), work rvu (+0.23)
N920	Excessive and frequent menstruation with regular cycle	No CC/MCC	0.697	8585	n j code lines (-0.45), or (+0.35), organ system count (+0.32)
N898	Other specified noninflammatory disorders of vagina	No CC/MCC	0.638	522	n distinct hcps (+0.30), organ system count (+0.19), work rvu (+0.08)
N841	Polyp of cervix uteri	No CC/MCC	0.633	969	work rvu (+0.35), organ system count (+0.25), relative claim charge (+0.14)
N946	Dysmenorrhea, unspecified	No CC/MCC	0.602	11174	organ system count (+0.32), or (+0.27), n distinct hcps (+0.15)
N809	Endometriosis, unspecified	No CC/MCC	0.552	5968	or (+0.29), organ system count (+0.25), relative claim charge (-0.11)
N9410	Unspecified dyspareunia	No CC/MCC	0.509	3435	or (+0.38), n distinct hcps (+0.38), organ system count (+0.25)
N938	Other specified abnormal uterine and vaginal bleeding	No CC/MCC	0.493	1267	n j code lines (-0.44), organ system count (+0.29), n distinct hcps (+0.29)
N7011	Chronic salpingitis	No CC/MCC	0.415	5976	organ system count (+0.27), work rvu (+0.18), relative claim charge (-0.10)
N945	Secondary dysmenorrhea	No CC/MCC	0.343	657	organ system count (+0.39), work rvu (-0.25), or (+0.18)

Tier 3 (n=32 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N80123	Deep endometriosis of bilateral ovaries	No CC/MCC	2.627	1274	relative claim charge (+1.33), n j code lines (+1.02), work rvu (+0.61)
N80353	Endometriosis of bilateral pelvic sidewall, unspecified depth	No CC/MCC	2.230	2018	or (+0.55), organ system count (+0.39), relative claim charge (+0.39)
N80121	Deep endometriosis of right ovary	No CC/MCC	2.216	1905	relative claim charge (+0.72), n j code lines (+0.50), organ system count (+0.39)
N80A0	Endometriosis of bladder, unspecified depth	No CC/MCC	2.201	1964	n j code lines (+0.50), or (+0.45), organ system count (+0.38)
N80202	Endometriosis of left fallopian tube, unspecified depth	No CC/MCC	2.060	1173	work rvu (+0.76), relative claim charge (+0.57), organ system count (+0.33)
N80103	Endometriosis of bilateral ovaries, unspecified depth	No CC/MCC	1.969	2587	relative claim charge (+0.60), organ system count (+0.41), or (+0.38)
D259	Leiomyoma of uterus, unspecified	No CC/MCC	1.930	5763	work rvu (+0.70), or (+0.49), relative claim charge (+0.31)
N803C3	Endometriosis of bilateral uterosacral ligament(s), unspecified depth	No CC/MCC	1.864	2702	or (+0.46), organ system count (+0.37), n j code lines (+0.32)
N80351	Endometriosis of the right pelvic sidewall, unspecified depth	No CC/MCC	1.832	1482	or (+0.39), organ system count (+0.35), n j code lines (+0.32)
N80203	Endometriosis of bilateral fallopian tubes, unspecified depth	No CC/MCC	1.810	693	work rvu (+0.66), relative claim charge (+0.39), organ system count (+0.34)

Tier 4 (n=14 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D251	Intramural leiomyoma of uterus	No CC/MCC	5.906	2400	or (+1.62), work rvu (+1.44), relative claim charge (+0.97)
N8003	Adenomyosis of the uterus	No CC/MCC	4.912	2618	or (+1.45), work rvu (+1.01), n distinct hcps (+0.90)
N72	Inflammatory disease of cervix uteri	No CC/MCC	4.798	1058	or (+1.81), n distinct hcps (+1.23), work rvu (+1.10)
N393	Stress incontinence (female) (male)	No CC/MCC	4.244	840	work rvu (+2.05), relative claim charge (+0.80), n distinct hcps (+0.57)
N888	Other specified noninflammatory disorders of cervix uteri	No CC/MCC	4.230	843	or (+1.36), n distinct hcps (+1.04), work rvu (+0.91)
D250	Submucous leiomyoma of uterus	No CC/MCC	3.993	1295	work rvu (+1.21), relative claim charge (+0.92), or (+0.90)
K682	Retroperitoneal fibrosis	No CC/MCC	3.814	1140	relative claim charge (+1.31), n j code lines (+1.02), work rvu (+0.69)
N8040	Endometriosis of rectovaginal septum, unspecified involvement of vagina	No CC/MCC	3.458	779	relative claim charge (+0.90), work rvu (+0.59), or (+0.58)
N8042	Endometriosis of rectovaginal septum with involvement of vagina	No CC/MCC	3.362	524	relative claim charge (+1.00), n j code lines (+0.73), work rvu (+0.71)
N80519	Endometriosis of the rectum, unspecified depth	No CC/MCC	3.356	1275	n j code lines (+1.21), relative claim charge (+1.07), work rvu (+0.51)

Key Driver Frequency

feature	count	pct
work rvu	83	60.600
or	77	56.200
organ system count	77	56.200
relative claim charge	75	54.700
n j code lines	51	37.200
n distinct hcps	32	23.400
n distinct rev codes	12	8.800
dialysis	3	2.200
transfusion	1	0.700