Last updated: June 9, 2017
| 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 |
| 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: | Use of Imaging Studies for Low Back Pain |
| 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. |
Specifications
CMS166v7_1.html
CMS166v7_1.xml- CMS166v7_SimpleXML_1.xml
EP_EC_CMS166v7_NQF0052_Low_Back_Pain_1.zip
CMS166v7_TRN_05.05.17_1.xlsx
Release Notes
Header
Incremented eMeasure Version number.
Section: eMeasure Version number
Source: Measure Lead
Updated Copyright.
Section: Copyright
Source: Annual Update
Updated Disclaimer.
Section: Disclaimer
Source: 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.
Section: Definition
Source: Measure Lead
Updated Guidance.
Section: Guidance
Source: Measure Lead
Added the word 'uncomplicated' to better describe the type of low back pain assessed in the measure.
Section: Initial Population
Source: 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).
Section: Denominator Exclusions
Source: 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.
Section: Denominator Exclusions
Source: Measure Lead
Replaced 'output or emergency department visit' with 'index episode start date' to align with HEDIS parent measure.
Section: Numerator
Source: Measure Lead
Logic
Added physical therapy, telehealth, and osteopathic or chiropractic manipulative treatment encounter types to align with the HEDIS parent measure.
Section: Initial Population
Source: Measure Lead
Updated the value set name from 'Low Back Pain' to 'Uncomplicated Low Back Pain' to align with the HEDIS parent measure.
Section: Initial Population
Source: 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.
Section: Denominator Exclusions
Source: 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.
Section: Denominator Exclusions
Source: 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.
Section: Denominator Exclusions
Source: 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.
Section: Numerator
Source: 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.
Section: None
Source: 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.
Section: None
Source: None
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.
Section: None
Source: None
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).
Section: None
Source: None
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).
Section: None
Source: None
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.
Section: None
Source: None
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.
Section: None
Source: None
Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.
Section: None
Source: None
Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.
Section: None
Source: None
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.
Section: None
Source: None
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.
Section: None
Source: None
Value set Spinal Infection (2.16.840.1.113883.3.464.1003.113.12.1063): Added Spinal Infection.
Section: None
Source: None
Value set Uncomplicated Low Back Pain (2.16.840.1.113883.3.464.1003.113.12.1001): Added Uncomplicated Low Back Pain.
Section: None
Source: None
Value set Osteopathic or Chiropractic Manipulative Treatment (2.16.840.1.113883.3.464.1003.101.12.1076): Added Osteopathic or Chiropractic Manipulative Treatment.
Section: None
Source: None
Value set Physical Therapy (2.16.840.1.113883.3.464.1003.118.12.1039): Added Physical Therapy.
Section: None
Source: None
Value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031): Added Telehealth Services.
Section: None
Source: None
Value set Kidney Transplant (2.16.840.1.113883.3.464.1003.109.12.1012): Added Kidney Transplant.
Section: None
Source: None
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.
Section: None
Source: None