Use of Imaging Studies for Low Back Pain*

Last updated: May 3, 2018

CMS Measure ID: CMS166v7
Version: 7
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

*This measure is for use in the Medicaid EHR Incentive Program for Eligible Professionals only.

Initial Patient Population:

Patients 18-50 years of age with a diagnosis of Uncomplicated low back pain during a visit

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Exclude patients with a diagnosis of uncomplicated low back pain during the 180 days (6 months) prior to the index episode start date.

Exclude patients with neurologic impairment, spinal infection, or diagnosis of IV drug abuse any time during the 12 months prior to the index episode start date through 28 days after the index episode start date.

Exclude patients with trauma any time during the 90 days prior to the index episode start date through 28 days after the index episode start date.

Exclude patients with a diagnosis of HIV or cancer any time in the patient's history through 28 days after the index episode start date.

Exclude patients who had a major organ transplant any time in the patient's history through 28 days after the index episode start date.

Exclude patients who had prolonged use of corticosteriods (at least 90 consecutive days) any time in the 12 months prior to the index episode start date.

Exclude patients who were in hospice care during the measurement year.

Numerator Statement:

Patients without an imaging study conducted on the index episode start date or in the 28 days following the index episode start date

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

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

Higher score indicates better quality

Guidance:

The visit in the Initial Population needs to occur during the first 337 days of the measurement period (337 days allows 28 days for the numerator event).

This visit must be the first visit for low back pain during the measurement period.

Notes: Measure removed from QPP reporting

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Added physical therapy, telehealth, and osteopathic or chiropractic manipulative treatment encounter types to align with the HEDIS parent measure and added definition of index episode start date.

    Measure Section: Definition

    Source of Change: Measure Lead

  • ​Updated Guidance.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added the word 'uncomplicated' to better describe the type of low back pain assessed in the measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Modified the Denominator Exclusions to align with the HEDIS parent measure, which include new exclusion criteria for HIV, spinal infection, kidney transplant, and 90 consecutive days of corticosteroids.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Replaced 'output or emergency department visit' with 'index episode start date' to align with HEDIS parent measure.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Added physical therapy, telehealth, and osteopathic or chiropractic manipulative treatment encounter types to align with the HEDIS parent measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the value set name from 'Low Back Pain' to 'Uncomplicated Low Back Pain' to align with the HEDIS parent measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Modified the Denominator Exclusions to align with the HEDIS parent measure, which include new exclusion criteria for HIV, spinal infection, kidney transplant, and 90 consecutive days of corticosteroids.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Replaced the 'starts before start of' and 'starts before end of' logical operator to address situations where time stamps are not attached to procedures, diagnosis, and immunizations. Wherever applicable, the operators have been changed to 'starts before or concurrent with start of' or 'starts before or concurrent with end of' respectively.

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-1936)

  • Replaced the 'starts before start of' and 'starts before end of' logical operator to address situations where time stamps are not attached to procedures, diagnosis, and immunizations. Wherever applicable, the operators have been changed to 'starts before or concurrent with start of' or 'starts before or concurrent with end of' respectively.

    Measure Section: Numerator

    Source of Change: JIRA (CQM-1936)

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • New value set Corticosteroids (2.16.840.1.113883.3.464.1003.196.12.1482) contains 68 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: Measure Lead

  • Value set IV Drug Abuse (2.16.840.1.113883.3.464.1003.106.12.1003): Deleted 32 ICD9CM codes. Deleted 62 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Low Back Pain (2.16.840.1.113883.3.464.1003.113.12.1001): Renamed Low Back Pain to Uncomplicated Low Back Pain.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Uncomplicated Low Back Pain (2.16.840.1.113883.3.464.1003.113.12.1001): Deleted 24 ICD9CM codes. Added 3 ICD10CM codes (M54.16, M54.17, M54.18) and deleted 5 ICD10CM codes (M46.46, M46.47, M46.48, M51.46, M51.47).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Neurologic impairment (2.16.840.1.113883.3.464.1003.114.12.1012): Deleted 4 SNOMEDCT codes (112102006, 16269008, 82473003, 84299009). Deleted 1 ICD9CM code (729.2). Deleted 6 ICD10CM codes (M54.16, M54.17, M54.18, M79.2, M99.03, M99.04).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Trauma (2.16.840.1.113883.3.464.1003.113.12.1036): Deleted 2 SNOMEDCT codes (287154000, 81102000). Deleted 1215 ICD9CM codes. Added 3 ICD10CM codes (S93.324A, S93.324D, S93.324S) and deleted 673 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set All Cancer (2.16.840.1.113883.3.464.1003.108.12.1011): Added 85 ICD9CM codes and deleted 2 ICD9CM codes (154.2, 154.3). Added 261 ICD10CM codes and deleted 2 ICD10CM codes (C21.0, C21.1). Added 28 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Spinal Infection (2.16.840.1.113883.3.464.1003.113.12.1063): Added Spinal Infection.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Uncomplicated Low Back Pain (2.16.840.1.113883.3.464.1003.113.12.1001): Added Uncomplicated Low Back Pain.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Osteopathic or Chiropractic Manipulative Treatment (2.16.840.1.113883.3.464.1003.101.12.1076): Added Osteopathic or Chiropractic Manipulative Treatment.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Physical Therapy (2.16.840.1.113883.3.464.1003.118.12.1039): Added Physical Therapy.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031): Added Telehealth Services.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Kidney Transplant (2.16.840.1.113883.3.464.1003.109.12.1012): Added Kidney Transplant.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Major Organ Transplant Other Than Kidney (2.16.840.1.113883.3.464.1003.198.12.1075): Added Major Organ Transplant Other Than Kidney.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set IV Drug Abuse (2.16.840.1.113883.3.464.1003.106.12.1003): Added 4 ICD10CM codes (F11.11, F13.11, F14.11, F15.11).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Uncomplicated Low Back Pain (2.16.840.1.113883.3.464.1003.113.12.1001): Added 2 ICD10CM codes (M48.061, M48.062).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Neurologic impairment (2.16.840.1.113883.3.464.1003.114.12.1012): Added 4 SNOMEDCT codes (112102006, 16269008, 82473003, 84299009).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Corticosteroids (2.16.840.1.113883.3.464.1003.196.12.1482): Added 13 RXNORM codes and deleted 2 RXNORM codes (308709, 309692).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set All Cancer (2.16.840.1.113883.3.464.1003.108.12.1011): Added 33 SNOMEDCT codes and deleted 3 SNOMEDCT codes (188651007, 421835000, 422052002). Added 4 ICD10CM codes (C96.20, C96.21, C96.22, C96.29).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources