• MIPS 2020—Quality: ICD-10 Turbulence and Changes in Clinical Guidelines

    This content is excerpted from EyeNet’s MIPS 2020; also see the Academy’s MIPS hub page.


    During the course of the performance year, quality mea­sures may be impacted by changes in diagnosis codes or in clinical best practices.

    On Oct. 1, CMS updates the ICD-10 code set—and this could have repercussions for quality measures. The quality performance category relies on ICD-10 codes (the diagnosis codes) to determine which patients are eligible for each quality measure. However, CMS updates the ICD-10 code set annually on Oct. 1, which is 75% of the way through the MIPS performance year. In some cases, these changes to the ICD-10 code set may mean that it would no longer be fair to compare your performance on a mea­sure to its historical benchmark—you would be comparing apples to oranges.

    Quality measures that are significantly impacted by ICD-10 changes will be subject to a nine-month assessment. After CMS has determined its changes to the ICD-10 code set, it will assess whether any quality measures are significantly impacted by those changes. It will publish a list of those measures on the CMS website at some point between Oct. 1, 2020, and Jan. 2, 2021. For the measures on that list, CMS would evaluate your performance based only on the first nine months of 2020, before the ICD-10 codes were changed.

    In rare cases, a quality measure may be “suppressed.” During the course of the year, changes in clinical guide­lines may mean that continued adherence to a measure could result in patient harm and/or provide misleading results as to good quality care. In the unlikely event that this happens with one of ophthalmology’s measures, CMS could suppress that measure. This means that if you sub­mitted data on the measure before it was suppressed—because, for example, you were reporting it by claims—1) you wouldn’t score points for that measure, and 2) when CMS calculates your quality score it would reduce your denominator by 10 points (so you wouldn’t be penalized for reporting the suppressed measure).

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