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ICD-10 and PQRS 2016

The revision of numerous ICD-10 codes on October 1, 2016, created issues for reporting PQRS measures for the final quarter of 2016.  Because PQRS data is gathered for a calendar year, participants expected the updated ICD-10 codes to be included in the applicable measures.  Unfortunately, this is not the case and CMS does not recognize the revised codes in the context of PQRS reporting. 

Good news!  CMS has announced that, should an eligible professional fail to report PQRS satisfactorily in 2016 because of the ICD-10 code updates, CMS will not penalize the provider with a payment adjustment in 2018. 

Providers who will be penalized for 2018 for failing the PQRS program, will not be notified until the fall of 2017.  At that time, a careful review of the report will be necessary to determine reason(s) for failure.  If it is due to the ICD-10 code changes, the opportunity to request an informal review exists. 

Corcoran Consulting Group is available to assist with your PQRS questions.  We can be reached at 800-399-6565.   (800) 399-6565


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