On October 1st of each year, the Centers for Medicare and Medicaid Services (CMS) releases updates to the International Statistical Classification of Diseases and Related Health Problems tenth revision (ICD-10), which assigns codes all possible diagnoses, symptoms, and medical procedures. These diagnosis codes are used to determine which patients are eligible for each quality measure.
How does this Affect MIPS?
Because the ICD-10 codes are updated towards the end of the MIPS Performance Year, quality measures specifications may change during your performance period. In 2018, CMS established an annual review process to identify which MIPS quality measures are impacted by the ICD-10 coding changes; this is evaluated by comparing the updated coding with the previous ones, considering the following criteria:
- Greater than 10 percent code changes in the measure numerator, denominator, exclusions, and exceptions.
- Clinical guideline changes, new products, or procedures reflected in ICD-10 code updates.
- Feedback on a measure received from measure developers and stewards.
Truncation or Suppression
If a quality measure is deemed to be significantly impacted by the ICD-10 update, that measure is either considered truncated or suppressed.
If a measure is truncated, that means that the clinician will report on nine consecutive months of performance data from January 1st to September 30th of this year. CMS will then score you on this measure based on your performance in this 9-month span.
If a measure is suppressed, it means that there isn’t sufficient performance data for that measure before its ICD-10 code was updated. You will not score any points for a suppressed measure; however, CMS will subtract 10 points from the denominator of your quality score for every suppressed measure, therefore suppressed measures do not have an impact on your final score.
What Quality Measures are Impacted:
According to CMS’ analysis, seven MIPS quality measures (see Table 1) are identified as being significantly impacted by 10% or more ICD-10 coding changes. The following measures have been truncated for the 2023 performance year:
- American Academy of Ophthalmology (AAO) – MIPS 2023—Quality: ICD-10 Turbulence and Changes in Clinical Guidelines
- Quality Payment Program Email Address for Questions or Concerns – QPP@cms.hhs.gov or call 1-866-288-8292 (Monday-Friday 8am- 8pm ET)