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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Tsugawa Y, Figueroa JF, Papanicolas I, Orav EJ, Jha AK. Assessment of Strategies for Managing Expansion of Diagnosis Coding Using Risk-Adjustment Methods for Medicare Data. JAMA Intern Med. Published online June 26, 2019. doi:10.1001/jamainternmed.2019.1005
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