CMS has announced a glitch in the quality reporting measures brought upon by the changes in the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) updates that went into affect Oct. 1.
Further reading: Top 5 tips for combatting 2017 coding concerns
While CMS is a bit unclear as to exactly what the problem is, there are a few things we know: This glitch only affects fourth quarter PQRS data, the components of PQRS affected seem to be the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) and it affects quality measure denominator calculations and seems to “undercount” the denominators.
“This means that for providers affected by the ICD-10 issue, they will not be subject to payment adjustments for 2017 or 2018 to eligible providers that are affected (as applicable),” says Dan Golder, DDS, principal at Impact Advisors, who has more than 30 years of regulatory and business consulting experience and specializes in strategic consulting for some of the largest healthcare organizations in the country. “Normally, these penalties under PQRS would be 2% of the Medicare fee schedule.”
Among the groups anticipated to be most affected are the Diabetes Measures Group, Cataracts Measures Group, Oncology Measures Group, Cardiovascular Prevention Measures Group and Diabetic Retinopathy Measures Group.
What should a doctor do?
Judy Waltz, a partner and health lawyer with Foley & Lardner LLP, notes physicians should be sure they have updated their systems to use the latest version of ICD-10 and that all their physicians and eligible professionals are using the latest and most specific codes, and/or providing adequate documentation to support the assignment of codes.