Use of Imaging Studies for Low Back Pain

Last updated: May 5, 2017

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 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
Domain: Efficiency and Cost Reduction
Next Version: Use of Imaging Studies for Low Back Pain
Previous Version: Use of Imaging Studies for Low Back Pain
Improvement Notation:

Higher score indicates better quality

Guidance:

The outpatient or emergency department 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.

Addendum Notes: ICD-10 Value Set addition

Specifications

Release Notes

Header

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Initial Patient Population to Initial Population 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 Exclusions

    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: Numerator

    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 Set

  • 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