ICD-10 Update Creates Problems for PQRS Reporting, Value Modifier

As if physicians don't have enough headaches and hassles to deal with to keep their practice doors open, the latest news from the American Medical Association is not good. It turns out the Oct. 1 ICD-10 update will negatively affect some physicians who participate in quality reporting for the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. To determine whether the update affects your specialty, review the list of affected quality measures.

Despite the recent ICD-10 update, specifications for all quality measures remain the same. Due to the timing in finalizing codes for the update and the number of codes involved, CMS did not update the measure specifications to include the coding changes, thereby creating problems for the PQRS and VM programs. This issue may lead to confusion for many physicians and groups, resulting in incorrect coding and failed reporting for the 2016 PQRS program year and payment penalties under both programs in 2018.

AMA reports it is working with CMS to resolve the issue and reports "the agency has assured the AMA that every effort will be made to prevent physicians from being penalized for issues resulting from the ICD-10 coding update." TMA will actively track this issue and will keep members informed as the association learns more. 

For more information, read this AMA article. And for guidance on quality reporting for the 2016 program year, visit the TMA PQRS and VM Resource Center

Action, Oct. 14, 2016 

Last Updated On

October 20, 2016

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