Glitch in ICD-10 update offers some physicians free pass on PQRS penalties

Issues with the October 2016 ICD-10 update mean CMS can’t process certain quality measure data for the last quarter of the year, so the agency will waive penalties related to the glitch’s impact on the Physician Quality Reporting System (PQRS).

The updates to the ICD-CM (Clinical Modification) and PCS (Procedural Coding System), which went into use on Oct. 1, 2016, “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 Jan. 9 statement.

“Therefore, CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any EP or group practice that fails to satisfactorily report for 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the fourth quarter of 2016,” CMS said.

In a related fact sheet, the agency said the coding changes affected 2016 PQRS measures related to diabetes, pregnancy, cardiovascular, oncology, mental health and eye disease diagnosis.

While penalties are being waived, reporting is still expected. CMS said eligible professionals and group practices still need to report 2016 PQRS measures regardless of whether they believe they have been impacted by the ICD-10 update. It’ll be up to the agency to decide whether the glitch affected their ability to satisfactorily report.

If a practice is found to have been affected by the update glitch, they’ll be removed from the PQRS payment adjustment “prior to the release of feedback reports.” Those who do receive payment adjustments can request a review if they believe it’s related to the coding update.

The agency didn’t mention any problems with PQRS reporting in the first three quarters of 2016.