Use of Imaging Studies for Low Back Pain

Last updated: May 18, 2016

CMS Measure ID: CMS166v4
Version: 4
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 Patient Population

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 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 Use of Healthcare Resources
Next Version: Use of Imaging Studies for Low Back Pain
Measure Score: Proportion
Score Type: Process
Improvement Notation:

Higher score indicates better quality

Guidance:

The outpatient or emergency department visit in the Initial Patient 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.

Specifications

External Resources