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Research Letter
June 26, 2019

Assessment of Strategies for Managing Expansion of Diagnosis Coding Using Risk-Adjustment Methods for Medicare Data

Author Affiliations
  • 1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA (University of California, Los Angeles)
  • 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 4Department of Health Policy, London School of Economics and Political Science, London, England
  • 5Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 6Veterans Affairs Healthcare System, Boston, Massachusetts
JAMA Intern Med. Published online June 26, 2019. doi:10.1001/jamainternmed.2019.1005

Since the passage of the Affordable Care Act (ACA) in 2010, many studies have used national Medicare data to examine associations between national hospital pay-for-performance programs and quality and costs of care.1-4 In January 2011, as the ACA was being implemented, the Centers for Medicare & Medicaid Services increased the number of available diagnosis billing codes from a maximum of 9 diagnosis codes (the primary diagnosis plus 8 comorbidities; a tenth code was reserved for coding external causes of injury and usually left blank5) to 25 diagnosis codes (the primary diagnosis plus 24 comorbidities).

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