PQRS vs ICD-10 coding: What physicians need to know

Carl Natale
by Carl Natale
PQRS vs ICD-10 coding: What physicians need to know

While the Centers for Medicare and Medicaid Services (CMS) announced it won't new Physician Quality Reporting System (PQRS) standards to healthcare providers. It appears the updated ICD-10 code sets could unfairly lower quality scores.

That doesn't mean there is any kind of delay in PQRS reporting. Healthcare providers still are responsible for certain standards — which means:

  • Update to the latest version of ICD-10-CM/PCS
  • Use the most specific codes
  • Support codes with proper documentation
  • Train billing staff to achieve most accurate reporting possible

Again, this doesn't mean PQRS is not in effect. There still are reporting requirements:

  • Sign up for PQRS (there is a penalty for not reporting)
  • Continue to report PQRS measures
  • Request an informal review if payments are adjusted due to low scores

One last note: ICD-10 specificity helps regulators and healthcare payers to hunt for waste, fraud and abuse in medical claims. Documenting and coding accurately will be a defense against such claims.