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Use of Imaging Studies for Low Back Pain

Last updated: May 3, 2018

CMS Measure ID: CMS166v6
Version: 6
NQF Number: 0052
Measure Description:

Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

Initial Patient Population:

Patients 18-50 years of age with a diagnosis of low back pain during an outpatient or emergency department visit

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:

Exclude patients with a diagnosis of cancer any time in their history or patients with a diagnosis of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to through the 28 days after the outpatient or emergency department visit.

Exclude patients with a diagnosis of low back pain within the 180 days prior to the outpatient or emergency department visit.

Numerator Statement:

Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visit

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Efficiency and Cost Reduction
Next Version:
Improvement Notation:

Higher score indicates better quality

Guidance:

The outpatient or emergency department visit in the Initial Populationinfo-icon needs to occur during the first 337 days of the measurement period (337 days allows 28 days for the numeratorinfo-icon event). This visit must be the first visit for low back pain during the measurement period.

Notes: Value Set content updated
Quality ID: 312
High Priority Measure: Yes
Data Submission Method: EHR
Specialty Measure Set: Orthopedic Surgery,Physical Medicine,General Practice/Family Medicine

Specifications

Release Notes

Header

  • ‚ÄčUpdated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Initial Patient Population to Initial Populationinfo-icon to align with the change to the QDM.

    Section: Guidance

    Source: Measure Lead

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

Logic

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Denominator Exclusionsinfo-icon

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Numeratorinfo-icon

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Variables

    Source: QDM Standards

Value Setinfo-icon

  • Value set CT Scan of Lower Spine (2.16.840.1.113883.3.464.1003.113.12.1035): Deleted 1 LOINC code (70928-7).

    Section: None

    Source: None

  • Value set Low Back Pain (2.16.840.1.113883.3.464.1003.113.12.1001): Deleted 2 ICD10CM codes (M43.27, M43.28).

    Section: None

    Source: None

  • Value set MRI of Lower Spine (2.16.840.1.113883.3.464.1003.113.12.1034): Deleted 1 LOINC code (38060-0).

    Section: None

    Source: None

  • Value set Neurologic impairment (2.16.840.1.113883.3.464.1003.114.12.1012): Added 1 ICD10CM code (M79.2).

    Section: None

    Source: None

  • Value set All Cancer (2.16.840.1.113883.3.464.1003.108.12.1011): Added 12 ICD10CM codes.

    Section: None

    Source: ICD-10 Addendum

  • Value set Trauma (2.16.840.1.113883.3.464.1003.113.12.1036): Added 669 ICD10CM codes.

    Section: None

    Source: ICD-10 Addendum

External Resources