Effective October 1, 2019

What is the Policy for Identifying Impacted Quality Measures?

In the calendar year (CY) 2018 Quality Payment Program final rule (82 FR 53716), the Centers for Medicare & Medicaid Services (CMS) finalized a process to stabilize measure data throughout the performance period when a measure is impacted by ICD-10 updates mid-performance period. ICD-10 code updates are effective annually on October 1 but quality measure specifications cannot be updated until the next MIPS program year. An annual review process was established to analyze and assess the quality measures to determine which measures are significantly impacted (determined by a 10% threshold) by ICD–10 code changes during the performance period.

CMS determines if a quality measure is significantly impacted by ICD-10 code updates by comparing the posted 2019 measure specifications with the ICD-10 codes that were deleted or added during the annual ICD-10 code updates, which will occur on October 1 of the performance period. If a quality measure is impacted by 10% or more ICD-10 code changes, the performance period and subsequent performance score for the affected quality measure will be based only on the first 9 months of the 12-month performance period. The criteria to suppress performance data includes:

  • 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 changes
  • Feedback on a measure received from measure developers and stewards

Which Quality Measures are Impacted for the 2019 Performance Period?

CMS has identified the following quality measures requiring performance data to be suppressed for the last quarter of the performance period. Performance data would be limited to the first nine months (January 1–September 30) of the performance period:

Quality Number Measure Title Primary Measure Steward Data Collection Type
326 Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy American College of Cardiology Medicare Part B Claims, MIPS CQM
392 HRS-12: Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation American College of Cardiology Foundation MIPS CQM

For the Medicare Part B Claims measure specification collection type, quality data codes submitted after September 30th will not be included in the data completeness and performance rate calculation.

Where Do I Go for Assistance?

If you have questions regarding the ICD-10 impact analysis, please contact the Quality Payment Program Service Center: