OP - UR.1.kidney_transplant

CM Codes

Data Overview

7770 total codes in komodo_rii; 114 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	82
CC	28
MCC	4

PCA Analysis

PC1 explains 37.8% of variance; PC1+PC2 together explain 56.5%.

Tier Clustering (k=5)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	work rvu	organ system count	n imaging lines	transfusion	relative claim charge	icu
1	34.000	47934.000	5.040	20.106	2.283	5.815	0.120	0.284	0.965	0.454
2	38.000	162416.000	5.475	20.902	2.367	5.570	0.144	0.335	0.998	0.508
3	26.000	36636.000	6.116	21.414	2.506	5.528	0.188	0.371	1.023	0.499
4	12.000	27744.000	6.636	22.284	2.273	5.456	0.226	0.455	1.064	0.575
5	4.000	3978.000	9.075	23.537	1.897	5.829	0.372	0.458	1.157	0.569

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5	All
CC	6	4	10	6	2	28
MCC	0	2	0	0	2	4
No CC/MCC	28	32	16	6	0	82
All	34	38	26	12	4	114

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.409	0.054	0.239
avg_length_of_stay	0.408	0.060	0.254
avg_n_imaging_lines	0.407	0.044	0.299
avg_relative_claim_charge	0.376	0.073	0.207
rate_transfusion	0.355	0.045	0.347
rate_mechanical_ventilation	0.317	-0.058	0.386
rate_icu	0.253	0.026	0.377
rate_or	0.184	0.057	0.262
rate_dialysis	0.142	-0.123	0.018
avg_n_j_code_lines	-0.002	-0.036	-0.007
avg_n_distinct_hcps	-0.003	-0.059	-0.321
avg_work_rvu	-0.023	0.116	0.171
avg_organ_system_count	-0.058	-0.306	-0.434
rate_multiple_or_days	-0.106	-0.003	0.035

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 5, No CC/MCC (0 codes)

None.

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

None.

Top Codes by Tier

Tier 1 (n=34 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E669	Obesity, unspecified	No CC/MCC	-1.510	2632	transfusion (-0.38), n imaging lines (-0.28), n distinct rev codes (-0.23)
E669	Obesity, unspecified	No CC/MCC	-1.510	2632	transfusion (-0.38), n imaging lines (-0.28), n distinct rev codes (-0.23)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-1.625	740	n imaging lines (-0.31), icu (-0.29), length of stay (-0.29)
J45909	Unspecified asthma, uncomplicated	No CC/MCC	-1.625	740	n imaging lines (-0.31), icu (-0.29), length of stay (-0.29)
F32A	Depression, unspecified	No CC/MCC	-1.733	958	n distinct rev codes (-0.33), relative claim charge (-0.26), icu (-0.25)
F32A	Depression, unspecified	No CC/MCC	-1.733	958	n distinct rev codes (-0.33), relative claim charge (-0.26), icu (-0.25)
F419	Anxiety disorder, unspecified	No CC/MCC	-1.948	838	n distinct rev codes (-0.48), n imaging lines (-0.34), length of stay (-0.27)
F419	Anxiety disorder, unspecified	No CC/MCC	-1.948	838	n distinct rev codes (-0.48), n imaging lines (-0.34), length of stay (-0.27)
E8342	Hypomagnesemia	No CC/MCC	-1.995	913	n distinct rev codes (-0.79), or (-0.74), dialysis (-0.25)
E8342	Hypomagnesemia	No CC/MCC	-1.995	913	n distinct rev codes (-0.79), or (-0.74), dialysis (-0.25)

Tier 2 (n=38 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	0.248	7076	or (+0.11), dialysis (-0.10), n distinct rev codes (+0.10)
E1122	Type 2 diabetes mellitus with diabetic chronic kidney disease	No CC/MCC	0.248	7076	or (+0.11), dialysis (-0.10), n distinct rev codes (+0.10)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	0.128	611	transfusion (-0.32), n imaging lines (-0.27), mechanical ventilation (+0.26)
E6601	Morbid (severe) obesity due to excess calories	No CC/MCC	0.128	611	transfusion (-0.32), n imaging lines (-0.27), mechanical ventilation (+0.26)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	0.001	732	icu (+0.49), relative claim charge (-0.39), length of stay (-0.11)
E7800	Pure hypercholesterolemia, unspecified	No CC/MCC	0.001	732	icu (+0.49), relative claim charge (-0.39), length of stay (-0.11)
E8339	Other disorders of phosphorus metabolism	No CC/MCC	-0.047	3719	mechanical ventilation (-0.18), n imaging lines (-0.16), icu (+0.14)
E8339	Other disorders of phosphorus metabolism	No CC/MCC	-0.047	3719	mechanical ventilation (-0.18), n imaging lines (-0.16), icu (+0.14)
N186	End stage renal disease	MCC	-0.061	18998	or (+0.13), mechanical ventilation (-0.12), n imaging lines (-0.09)
N186	End stage renal disease	MCC	-0.061	18998	or (+0.13), mechanical ventilation (-0.12), n imaging lines (-0.09)

Tier 3 (n=26 codes)

code	Description	CMS severity	Score	N claims	Key drivers
E8770	Fluid overload, unspecified	No CC/MCC	1.780	822	length of stay (+0.47), mechanical ventilation (+0.38), n distinct rev codes (+0.28)
E8770	Fluid overload, unspecified	No CC/MCC	1.780	822	length of stay (+0.47), mechanical ventilation (+0.38), n distinct rev codes (+0.28)
I5032	Chronic diastolic (congestive) heart failure	CC	1.649	739	mechanical ventilation (+0.61), transfusion (+0.33), n imaging lines (+0.26)
I5032	Chronic diastolic (congestive) heart failure	CC	1.649	739	mechanical ventilation (+0.61), transfusion (+0.33), n imaging lines (+0.26)
N179	Acute kidney failure, unspecified	CC	1.643	1162	mechanical ventilation (+0.44), n imaging lines (+0.42), length of stay (+0.36)
N179	Acute kidney failure, unspecified	CC	1.643	1162	mechanical ventilation (+0.44), n imaging lines (+0.42), length of stay (+0.36)
E871	Hypo-osmolality and hyponatremia	CC	1.608	3277	length of stay (+0.33), relative claim charge (+0.29), n imaging lines (+0.29)
E871	Hypo-osmolality and hyponatremia	CC	1.608	3277	length of stay (+0.33), relative claim charge (+0.29), n imaging lines (+0.29)
E876	Hypokalemia	No CC/MCC	1.311	876	mechanical ventilation (+0.45), icu (+0.37), relative claim charge (-0.28)
E876	Hypokalemia	No CC/MCC	1.311	876	mechanical ventilation (+0.45), icu (+0.37), relative claim charge (-0.28)

Tier 4 (n=12 codes)

code	Description	CMS severity	Score	N claims	Key drivers
D62	Acute posthemorrhagic anemia	CC	3.923	3550	transfusion (+1.30), icu (+0.55), n distinct rev codes (+0.47)
D62	Acute posthemorrhagic anemia	CC	3.923	3550	transfusion (+1.30), icu (+0.55), n distinct rev codes (+0.47)
T8619	Other complication of kidney transplant	CC	3.724	4504	n distinct rev codes (+0.77), relative claim charge (+0.74), length of stay (+0.64)
T8619	Other complication of kidney transplant	CC	3.724	4504	n distinct rev codes (+0.77), relative claim charge (+0.74), length of stay (+0.64)
I959	Hypotension, unspecified	No CC/MCC	3.190	771	n distinct rev codes (+0.70), transfusion (+0.62), length of stay (+0.53)
I959	Hypotension, unspecified	No CC/MCC	3.190	771	n distinct rev codes (+0.70), transfusion (+0.62), length of stay (+0.53)
D696	Thrombocytopenia, unspecified	No CC/MCC	3.137	2146	transfusion (+0.74), n distinct rev codes (+0.62), n imaging lines (+0.42)
D696	Thrombocytopenia, unspecified	No CC/MCC	3.137	2146	transfusion (+0.74), n distinct rev codes (+0.62), n imaging lines (+0.42)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	2.951	2368	mechanical ventilation (+0.48), n imaging lines (+0.45), relative claim charge (+0.45)
I132	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease	CC	2.951	2368	mechanical ventilation (+0.48), n imaging lines (+0.45), relative claim charge (+0.45)

Tier 5 (n=4 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N170	Acute kidney failure with tubular necrosis	MCC	7.892	1482	length of stay (+1.71), n imaging lines (+1.50), relative claim charge (+1.43)
N170	Acute kidney failure with tubular necrosis	MCC	7.892	1482	length of stay (+1.71), n imaging lines (+1.50), relative claim charge (+1.43)
K567	Ileus, unspecified	CC	7.260	507	n imaging lines (+1.59), mechanical ventilation (+1.44), length of stay (+1.40)
K567	Ileus, unspecified	CC	7.260	507	n imaging lines (+1.59), mechanical ventilation (+1.44), length of stay (+1.40)

Key Driver Frequency

feature	count	pct
n imaging lines	54	47.400
length of stay	54	47.400
relative claim charge	52	45.600
n distinct rev codes	50	43.900
mechanical ventilation	42	36.800
icu	32	28.100
transfusion	30	26.300
or	16	14.000
dialysis	6	5.300
multiple or days	4	3.500
organ system count	2	1.800

PCS Codes

Data Overview

2736 total codes in komodo_rii; 30 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 48.5% of variance; PC1+PC2 together explain 65.0%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	work rvu	organ system count	n j code lines	transfusion	relative claim charge	n imaging lines
1	20.000	58494.000	21.481	5.697	2.554	5.028	1.545	0.357	1.002	0.168
2	6.000	17358.000	23.689	7.510	4.288	5.361	1.752	0.610	1.119	0.311
3	4.000	3990.000	25.343	9.400	1.490	5.550	1.356	0.613	1.244	0.367

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.376	-0.484
avg_length_of_stay	0.370	-0.375
avg_n_imaging_lines	0.367	-0.459
avg_relative_claim_charge	0.363	-0.088
avg_organ_system_count	0.357	-0.127
rate_mechanical_ventilation	0.309	-0.316
rate_transfusion	0.285	-0.181
rate_dialysis	0.234	-0.293
rate_multiple_or_days	0.196	-0.004
rate_or	0.189	-0.515
avg_n_distinct_hcps	0.141	-0.014
rate_icu	0.036	-0.256
avg_work_rvu	-0.011	-0.181
avg_n_j_code_lines	-0.014	-0.227

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=20 codes)

code	Description	Score	N claims	Key drivers
6ABT0BZ	PERFUSION OF URINARY SYSTEM DONOR ORGAN, SINGLE	-0.707	876	relative claim charge (-0.22), mechanical ventilation (-0.22), n imaging lines (-0.20)
6ABT0BZ	PERFUSION OF URINARY SYSTEM DONOR ORGAN, SINGLE	-0.707	876	relative claim charge (-0.22), mechanical ventilation (-0.22), n imaging lines (-0.20)
0T160ZB	BYPASS RIGHT URETER TO BLADDER, OPEN APPROACH	-0.741	562	relative claim charge (-0.27), n distinct hcps (-0.27), multiple or days (+0.18)
0T160ZB	BYPASS RIGHT URETER TO BLADDER, OPEN APPROACH	-0.741	562	relative claim charge (-0.27), n distinct hcps (-0.27), multiple or days (+0.18)
30233S1	TRANSFUSION OF NONAUTOLOGOUS GLOBULIN INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.264	964	organ system count (-0.34), n imaging lines (-0.25), length of stay (-0.21)
30233S1	TRANSFUSION OF NONAUTOLOGOUS GLOBULIN INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-1.264	964	organ system count (-0.34), n imaging lines (-0.25), length of stay (-0.21)
3E0T3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	-1.369	797	organ system count (-0.55), length of stay (-0.34), n imaging lines (-0.27)
3E0T3BZ	INTRODUCTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVES AND PLEXI, PERCUTANEOUS APPROACH	-1.369	797	organ system count (-0.55), length of stay (-0.34), n imaging lines (-0.27)
0T768DZ	DILATION OF RIGHT URETER WITH INTRALUMINAL DEVICE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-1.580	652	organ system count (-0.26), multiple or days (-0.26), length of stay (-0.25)
0T768DZ	DILATION OF RIGHT URETER WITH INTRALUMINAL DEVICE, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-1.580	652	organ system count (-0.26), multiple or days (-0.26), length of stay (-0.25)

Tier 2 (n=6 codes)

code	Description	Score	N claims	Key drivers
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.081	2071	transfusion (+0.89), n imaging lines (+0.52), n distinct rev codes (+0.38)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	3.081	2071	transfusion (+0.89), n imaging lines (+0.52), n distinct rev codes (+0.38)
0TB00ZX	EXCISION OF RIGHT KIDNEY, OPEN APPROACH, DIAGNOSTIC	1.978	535	n imaging lines (+0.54), n distinct rev codes (+0.34), length of stay (+0.34)
0TB00ZX	EXCISION OF RIGHT KIDNEY, OPEN APPROACH, DIAGNOSTIC	1.978	535	n imaging lines (+0.54), n distinct rev codes (+0.34), length of stay (+0.34)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	1.632	6073	dialysis (+0.51), organ system count (+0.31), relative claim charge (+0.24)
5A1D70Z	PERFORMANCE OF URINARY FILTRATION, INTERMITTENT, LESS THAN 6 HOURS PER DAY	1.632	6073	dialysis (+0.51), organ system count (+0.31), relative claim charge (+0.24)

Tier 3 (n=4 codes)

code	Description	Score	N claims	Key drivers
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	5.388	579	relative claim charge (+0.97), length of stay (+0.94), n distinct rev codes (+0.88)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	5.388	579	relative claim charge (+0.97), length of stay (+0.94), n distinct rev codes (+0.88)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	4.838	1416	mechanical ventilation (+0.99), length of stay (+0.57), organ system count (+0.56)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	4.838	1416	mechanical ventilation (+0.99), length of stay (+0.57), organ system count (+0.56)

Key Driver Frequency

feature	count	pct
length of stay	16	53.300
n imaging lines	16	53.300
n distinct rev codes	16	53.300
organ system count	10	33.300
mechanical ventilation	8	26.700
relative claim charge	8	26.700
or	4	13.300
multiple or days	4	13.300
dialysis	4	13.300
n distinct hcps	2	6.700
transfusion	2	6.700