OP - UR.0.cystourethroscopy

CM Codes

Data Overview

7542 total codes in komodo_rii; 221 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	170
CC	49
MCC	2

PCA Analysis

PC1 explains 36.6% of variance; PC1+PC2 together explain 50.8%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n j code lines	work rvu	n distinct rev codes	organ system count	relative claim charge	or	n distinct hcps	n imaging lines
1	11.000	13378.000	3.904	5.155	6.486	3.044	0.746	0.725	0.801	0.020
2	50.000	287769.000	6.342	6.908	7.931	3.277	0.934	0.847	0.728	0.021
3	160.000	1067739.000	7.488	8.459	8.788	4.138	1.095	0.883	0.717	0.048

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	6	22	21	49
MCC	1	0	1	2
No CC/MCC	4	28	138	170
All	11	50	160	221

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_j_code_lines	0.440	0.070	-0.318
avg_n_distinct_rev_codes	0.433	0.093	-0.238
avg_relative_claim_charge	0.421	0.058	-0.355
avg_work_rvu	0.381	0.057	-0.351
rate_or	0.291	0.007	-0.187
avg_organ_system_count	0.239	-0.013	-0.336
avg_n_imaging_lines	0.204	0.039	-0.149
rate_icu	0.091	0.284	0.078
rate_mechanical_ventilation	0.050	0.143	0.164
avg_length_of_stay	-0.000	nan	nan
rate_multiple_or_days	-0.000	nan	nan
rate_transfusion	-0.163	0.006	0.249
avg_n_distinct_hcps	-0.176	-0.125	-0.098
rate_dialysis	-0.212	0.362	0.104

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
D72829	Elevated white blood cell count, unspecified	No CC/MCC	4.520	3	1252	n imaging lines (+1.33), n distinct rev codes (+1.31), n j code lines (+0.76)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	4.498	3	1299	n distinct rev codes (+1.23), n imaging lines (+1.11), n j code lines (+0.61)
E876	Hypokalemia	No CC/MCC	3.230	3	1042	n distinct rev codes (+0.73), n imaging lines (+0.72), n j code lines (+0.62)
K8020	Calculus of gallbladder without cholecystitis without obstruction	No CC/MCC	3.204	3	624	n imaging lines (+0.99), n distinct rev codes (+0.98), work rvu (+0.47)
F4310	Post-traumatic stress disorder, unspecified	No CC/MCC	2.878	3	1082	mechanical ventilation (+0.74), n j code lines (+0.45), work rvu (+0.37)

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

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
N186	End stage renal disease	MCC	-6.293	1	2900	n j code lines (-1.21), relative claim charge (-1.09), dialysis (-1.04)

Top Codes by Tier

Tier 1 (n=11 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I120	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	CC	-4.244	1768	dialysis (-0.99), relative claim charge (-0.88), work rvu (-0.82)
N185	Chronic kidney disease, stage 5	CC	-4.398	509	relative claim charge (-0.99), work rvu (-0.83), n j code lines (-0.82)
T8389XA	Other specified complication of genitourinary prosthetic devices, implants and grafts, initial encounter	CC	-4.599	1334	n distinct rev codes (-1.02), n j code lines (-0.93), relative claim charge (-0.79)
N209	Urinary calculus, unspecified	No CC/MCC	-5.096	981	or (-1.31), n distinct rev codes (-1.18), n j code lines (-1.01)
E8342	Hypomagnesemia	No CC/MCC	-5.824	721	n j code lines (-1.64), or (-1.24), relative claim charge (-1.21)
Q6239	Other obstructive defects of renal pelvis and ureter	CC	-6.225	667	n distinct rev codes (-1.41), relative claim charge (-1.32), n j code lines (-1.06)
N186	End stage renal disease	MCC	-6.293	2900	n j code lines (-1.21), relative claim charge (-1.09), dialysis (-1.04)
T191XXA	Foreign body in bladder, initial encounter	No CC/MCC	-7.579	1159	or (-2.00), n distinct rev codes (-1.80), n j code lines (-1.45)
D84821	Immunodeficiency due to drugs	No CC/MCC	-8.672	806	n j code lines (-2.05), relative claim charge (-1.33), n distinct rev codes (-1.31)
T8619	Other complication of kidney transplant	CC	-8.770	1138	n j code lines (-1.58), dialysis (-1.36), n distinct rev codes (-1.36)

Tier 2 (n=50 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N320	Bladder-neck obstruction	No CC/MCC	-0.435	973	organ system count (-0.28), relative claim charge (-0.27), work rvu (+0.18)
N3946	Mixed incontinence	No CC/MCC	-0.505	726	relative claim charge (-0.29), n j code lines (-0.17), n distinct hcps (+0.14)
N289	Disorder of kidney and ureter, unspecified	No CC/MCC	-0.505	2077	n j code lines (-0.28), organ system count (-0.19), dialysis (+0.05)
N3080	Other cystitis without hematuria	No CC/MCC	-0.531	1096	n distinct rev codes (-0.41), organ system count (-0.34), n j code lines (-0.23)
D696	Thrombocytopenia, unspecified	No CC/MCC	-0.546	1310	transfusion (-1.45), relative claim charge (+0.35), organ system count (+0.28)
E559	Vitamin D deficiency, unspecified	No CC/MCC	-0.628	3054	n distinct rev codes (-0.20), n distinct hcps (-0.20), or (-0.19)
C670	Malignant neoplasm of trigone of bladder	No CC/MCC	-0.636	688	work rvu (+0.49), or (-0.37), n distinct rev codes (-0.19)
Q631	Lobulated, fused and horseshoe kidney	No CC/MCC	-0.724	639	organ system count (-0.42), n distinct rev codes (-0.32), or (-0.23)
N138	Other obstructive and reflux uropathy	CC	-0.739	6340	organ system count (-0.31), or (-0.25), n j code lines (-0.21)
N401	Benign prostatic hyperplasia with lower urinary tract symptoms	No CC/MCC	-0.796	11681	n j code lines (-0.31), or (-0.28), organ system count (-0.27)

Tier 3 (n=160 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D72829	Elevated white blood cell count, unspecified	No CC/MCC	4.520	1252	n imaging lines (+1.33), n distinct rev codes (+1.31), n j code lines (+0.76)
K5730	Diverticulosis of large intestine without perforation or abscess without bleeding	No CC/MCC	4.498	1299	n distinct rev codes (+1.23), n imaging lines (+1.11), n j code lines (+0.61)
E876	Hypokalemia	No CC/MCC	3.230	1042	n distinct rev codes (+0.73), n imaging lines (+0.72), n j code lines (+0.62)
K8020	Calculus of gallbladder without cholecystitis without obstruction	No CC/MCC	3.204	624	n imaging lines (+0.99), n distinct rev codes (+0.98), work rvu (+0.47)
A419	Sepsis, unspecified organism	MCC	3.204	723	n distinct rev codes (+0.84), icu (+0.76), n imaging lines (+0.49)
F4310	Post-traumatic stress disorder, unspecified	No CC/MCC	2.878	1082	mechanical ventilation (+0.74), n j code lines (+0.45), work rvu (+0.37)
N179	Acute kidney failure, unspecified	CC	2.799	7496	n distinct rev codes (+0.92), n imaging lines (+0.76), relative claim charge (+0.36)
N136	Pyonephrosis	CC	2.732	4191	n distinct rev codes (+1.01), n imaging lines (+0.75), n distinct hcps (+0.56)
E871	Hypo-osmolality and hyponatremia	CC	2.666	557	icu (+0.99), n distinct rev codes (+0.81), n imaging lines (+0.62)
M549	Dorsalgia, unspecified	No CC/MCC	2.527	1421	relative claim charge (+0.47), n distinct rev codes (+0.45), organ system count (+0.37)

Key Driver Frequency

feature	count	pct
relative claim charge	123	55.700
n j code lines	108	48.900
n distinct rev codes	106	48.000
work rvu	84	38.000
organ system count	81	36.700
or	77	34.800
n distinct hcps	38	17.200
n imaging lines	19	8.600
transfusion	14	6.300
dialysis	9	4.100
icu	3	1.400
mechanical ventilation	1	0.500