ICD-10 glitch leads CMS to relax physician quality penalties
The CMS issued something of a get-out-of-Medicare-penalties-free-card for two years to physicians and group practices due to a glitch with quality reporting measures based on a recent update to the ICD-10 diagnosis and procedure codes.
The CMS pointed its finger at updates that went into use Oct. 1, 2016, to the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) and their impact on the Physician Quality Reporting System.
The updates “will impact CMS’s ability to process data reported on certain quality measures for the 4th quarter of CY 2016,” the agency said in a statement posted on its website.
The CMS said it will not apply the 2017 or 2018 PQRS payment adjustments to any “eligible professional” or “group practice that fails to satisfactorily report for (calendar year) 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of (CY) 2016.”
“What they’re basically saying is that new coding updates apparently had some impact on their quality measures and they will not be able to process data on those,” said Stanley Nachimson, a health IT consultant expert on the ICD-10 codes. “It sounds like the first three quarters were fine, but in the fourth quarter it had some impact on their quality measures. They’re not going to penalize providers if they couldn’t come up with PQRS quality measures.”
Normally under the PQRS program, penalties are 2% of the Medicare fee schedule.
According to a page of frequently asked questions, problem areas concentrated in certain medical specialties, notes Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association.
“It says the majority of the codes are for diabetes, pregnancy, cardiovascular, oncology, mental health and eye diseases,” Bowman said.
So, when will the ICD-10 code update itself be updated?
Bowman said that’s not specified. But at least the CMS acknowledged the problem and is taking steps to correct it and mitigate its impact, she said.
“The CMS is pretty good about working with providers,” she said. “They recognized this is a problem and the providers shouldn’t be penalized for it.”