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Use of Imaging Studies for Low Back Pain (LBP)

Based on current NCQA HEDIS recommendations, your TO-DO LIST for members ages 18 to 50 should include:

  • An imaging study with a diagnosis of uncomplicated low back pain

Why should you complete your TO-DO LIST?

It is an evidence-based, best practice and these actions are used to measure your quality performance.

Use of Imaging Studies for Low Back Pain (LBP) Definition:

(NCQA HEDIS guidelines, Measurement Year (MY) 2022)

  • The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.
  • Line of Business: Commercial, Medicaid

Requirement:

  • An imaging study (Imaging Study Value Set) with a diagnosis of uncomplicated low back pain (Uncomplicated Low Back Pain Value Set) on the IESD or in the 28 days following the IESD.

IESD(IndexEpisodeStartDate) - The earliest date of service for an eligible encounter during the Intake Period with a principal diagnosis of low back pain.

* The measure is reported as an inverted rate [1–(numerator/eligible population)]. A higher score indicates appropriate treatment of low back pain (i.e., the proportion for whom imaging studies did not occur).

How does your completion of the TO-DO LIST get recorded?

Codes Related to Low Back Pain

Imaging Study

CPT 72020 72052 72100 72110 72114 72120 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 72158 72200 72202 72220

SNOMED CT US Edition  2847006 6238009 6728003 7812007 21613005 22791004 24856003 26537001 35443000 41333006 45554006 46700000 47987001 48816001 57235004 60443006 61368000 66769009 68862002 72508000 79760008 86392000 90523008 90805008 91333005 91583001 168573004 168588009 241092006 241093001 241094007 241580002 241596004 241646009 241647000 241648005 276478001 303935004 419942003 429860003 431250008 431496002 431557005 431613003 431871005 431892005 432078003 432770001 433140006 433141005 443580006 444634007 448641007 700319007 700320001 700321002 702487007 702488002 702513003 702514009 702515005 702516006 702521009 702522002 702523007 702607002 702608007 709652000 709653005 709698004 711104001 711184004 711186002 711271003 712970008 713016000 715458009 716830000 717912001 718542005 718545007 726546000 772220000 783627007 840361000 868279006 3721000087104 3731000087102 14871000087107 17141000087101 394451000119106 396171000119100 411571000119106 411611000119102 413001000119107 495741000119105 571891000119109 572091000119106

 

Uncomplicated Low Back Pain

ICD10CM M47.26 M47.27 M47.28 M47.816 M47.817 M47.818 M47.896 M47.897 M47.898 M48.061 M48.07 M48.08 M51.16 M51.17 M51.26 M51.27 M51.36 M51.37 M51.86 M51.87 M53.2X6 M53.2X7 M53.2X8 M53.3 M53.86 M53.87 M53.88 M54.16 M54.17 M54.18 M54.30 M54.31 M54.32 M54.40 M54.41 M54.42 M54.5 M54.89 M54.9 M99.03 M99.04 M99.23 M99.33 M99.4 M99.53 M99.63 M99.73 M99.83 M99.84 S33.100A S33.100D S33.100S S33.110A S33.110D S33.110S S33.120A S33.120D S33.120S S33.130A S33.130D S33.130S S33.140A S33.140D S33.140S S33.5XXA S33.6XXA S33.8XXA S33.9XXA S39.002A S39.002D S39.002S S39.012A S39.012D S39.012S S39.092A S39.092D S39.092S S39.82XA S39.82XD S39.82XS S39.92XA S39.92XD S39.92XS

SNOMED CT US Edition  2415007 3200003 8663007 12454008 12519004 18347007 20021007 23056005 26538006 29885006 38253002 39058009 41455002 46578006 46960006 48210000 54314008 60937000 61486003 86345004 86814006 90631008 91240008 92047003 93743001 94242004 94782007 111633007 111653006 123534001 123535000 123798002 126963001 128196005 128197001 129179000 161894002 163241009 163243007 192970008 192971007 202487003 202674000 202675004 202676003 202677007 202678002 202679005 202680008 202693003 202694009 202695005 202696006 202708005 202731005 202735001 202736000 202755000 202787002 202788007 202789004 202794004 202824000 208060001 208067003 208071000 208078006 209086000 209102002 209169008 209178002 209179005 209180008 209181007 209182000 209185003 209193003 209194009 209195005 209196006 209197002 209547009 209548004 209549007 209550007 209551006 209552004 209553009 209561004 209565008 209566009 209812006 212192004 212193009 212457004 230614002 239880009 247368002 262726002 262727006 262731000 262732007 262995003 263044008 267067009 267590006 267982002 274162005 275316003 278860009 278862001 279039007 279040009 279042001 279063004 281598004 298251000 298604007 298605008 298674008 300956001 300957005 301407002 301408007 301416003 301417007 307138004 307176005 307177001 309710005 311804006 312788000 312792007 363477002 370471003 405753002 416513001 416546007 416929004 417056009 417068000 417098007 417262009 417414000 417459008 417614006 417646006 417685004 417725008 417731006 417744001 427027005 427571000 427923007 703619001 713911007 718929000 718936004 724899004 735609006 735610001 735611002 737254001 764272007 782388003 782661001 830292003 830293008 838412000 860614004 871492003 1119215001 1119216000  471000119102 9121000119106 13291000119100 36241000119108 100491000119103 113611000119100 129501000119107 291941000119106 291951000119108 311211000119105 313501000119105 322141000119100 448701000124105 12242551000119102 12242591000119107 15633361000119103 15634631000119104 15636531000119108 15636571000119106 15636611000119102 15749221000119107 15749261000119102 15749301000119105 15968741000119100 15972821000119108 16206741000119104 16839401000119104 16846261000119106 29930001000004103

To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please contact Horizon Healthy Journey: 1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2022 Technical Specs CPT® is a registered trademark of the American Medical Association.