Are you exempt from ICD-10 PQRS penalties in 2016?

January 18, 2017
Area(s) of Interest: Practice Management 

On October 1, 2016, new ICD-10 code sets went into effect that will impact the ability of the Centers for Medicare and Medicaid Services (CMS) to process data reported on certain quality measures for the fourth quarter of 2016. Because of this, CMS announced that it will waive 2017 or 2018 Physician Quality Reporting System (PQRS) payment adjustments, if applicable, for any physician 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.

Physicians and group practices must still report on 2016 PQRS measures, regardless of whether they believe they will be unable to satisfactorily report due to the ICD-10-CM code updates. CMS will determine after the data is submitted whether the clinician or group practice was among those impacted. The affected practices will be removed from the PQRS penalty prior to the release of the 2016 feedback reports. 

CMS is anticipating that the following measure groups may be affected by the ICD- 10 code updates:

  • Diabetes
  • Cataracts
  • Oncology
  • Cardiovascular Prevention
  • Diabetic Retinopathy

The 2016 reporting deadline is February 28, 2017.

Click here to read the CMS FAQ on the ICD-update and its impact on PQRS.


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