Use of Imaging Studies for Low Back Pain

Last updated: May 17, 2016

CMS Measure ID: CMS166v5
Version: 5
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 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 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
National Quality Strategy Domain: Efficiency and Cost Reduction Use of Healthcare Resources
Next Version: Use of Imaging Studies for Low Back Pain
Previous Version: Use of Imaging Studies for Low Back Pain
Measure Score: Proportion
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

Release Notes

Header

  • Copyright updated.
  • eMeasure version number incremented.

Logic

  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced variable $LBPEncounter and $DiagnosisTraumaIVDrugNeuroImpairment to allow re-use of logical expressions and reduce redundancy/complexity.
  • Replaced 'ORs' with 'Union of' operator.
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.
  • Updated Denominator Exclusion for active diagnosis of trauma, IV drug abuse, and neurologic impairment. Original logic stated that these denominator exclusions were valid if any occurred '<=365 day(s) starts before end of 'Measurement Period'.' The logic now states that these exclusions are valid if any should occur '<=365 day(s) starts before or concurrent with start of Occurrence A of $LBPEncounter.'

Value Sets

  • Value set All Cancer (OID 2.16.840.1.113883.3.464.1003.108.12.1011): Added 350 ICD10CM codes.
  • Value set IV Drug Abuse (OID 2.16.840.1.113883.3.464.1003.106.12.1003): Added 62 ICD10CM codes.
  • Value set Low Back Pain (OID 2.16.840.1.113883.3.464.1003.113.12.1001): Added 40 ICD10CM codes.
  • Value set Neurologic impairment (OID 2.16.840.1.113883.3.464.1003.114.12.1012): Deleted 2 ICD10CM codes (M54.10, M79.2), added 5 ICD10CM codes (M54.16, M54.17, M54.18, M99.03, M99.04).
  • Value set Trauma (OID 2.16.840.1.113883.3.464.1003.113.12.1036): Deleted 2057 ICD10CM codes, added 117 ICD10CM codes, added 3 ICD9CM codes (808.44, 808.54, 952.02), deleted 1 SNOMED code (208268000).

External Resources