Health IT Pulse

Jan 11 2017   10:12AM GMT

ICD-10 glitches cause CMS to back off

Shaun Sutner Shaun Sutner Profile: Shaun Sutner


It turns out the transition to ICD-10 didn’t go quite as smoothly as previously thought, particularly for the small practice physicians who were most anxious about the changeover from ICD-9 on Oct. 1, 2015.

What happened apparently is that some ICD-10 medical codes used in the Physician Quality Reporting System (PQRS) were not updated in time for CMS to process data reported on certain quality measures for eligible practitioners (EP) for the fourth quarter of calendar year (CY) 2016.

As a result, CMS is waiving reimbursement penalties for physicians and group practices that were affected by the ICD-10 glitches.

According to a CMS message released Jan. 9, “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 CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016.”

The influential American Academy of Family Physicians (AAFP) is among the groups hailing the CMS move.

“CMS is saying that while considerable work was done to incorporate ICD-10 changes into the measure specifications, there are still some problems and that work is still incomplete,” Sandy Pogones, the AAFP’s senior strategist for healthcare quality, was quoted as saying in a story on the AAFP’s web site. “Those codes have to be fully accounted for in the specifications and documented in the medical record for a physician to accurately report quality data.”

Pogones noted, however, “if a physician fails to meet reporting requirements for other reasons — say a physician just chooses not to report, or a group fails to meet the reporting threshold — then the penalty waiver doesn’t apply.”

CMS has published this FAQ to help physicians navigate PQRS requirements related to ICD-10.

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