2017-01-11 14:36:56 UTC

ICD-10 Update Snag Means Some May Avoid PQRS Penalties

Jan. 11, 2017

CMS will analyze 2016 data to determine which practices and practitioners were negatively affected.

CMS announced Jan. 9 that it will not apply the 2017 or 2018 Physician Quality Reporting System (PQRS) payment adjustments to any eligible professional (EP) or group practice that fails to satisfactorily report for calendar year 2016 due to a glitch in code updates.

The glitch occurred during the code updates that went into effect Oct. 1, 2016, to the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System).The majority of the ICD-10-CM coding changes that impacted 2016 PQRS measures were related to diabetes, pregnancy, cardiovascular, oncology, mental health and eye disease diagnosis.

In the ICD-10-CM FAQ, CMS indicated that it will perform an analysis after the close of the 2016 PQRS reporting period to determine which group practices and EPs were negatively impacted by the ICD-10-CM coding changes. The group practices and EPs affected by the impact of the ICD-10-CM code updates will be removed from the PQRS payment adjustment prior to the release of feedback reports and they will not be subject to the 2018 payment adjustment.

However, if an individual EP or group practice failed to satisfactorily report due to other reasons, they will be subject to the 2018 payment adjustment. Normally under the PQRS program, penalties are 2 percent of the Medicare fee schedule.

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