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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) 2020 & MY 2021)

  • 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 Value Set

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:
14871000087107, 168573004, 168588009, 21613005, 22791004, 241092006, 241093001, 241094007, 241580002, 241596004, 241646009, 241647000, 241648005, 24856003, 26537001, 276478001, 2847006, 303935004, 35443000, 394451000119106, 396171000119100, 411571000119106, 411611000119102, 413001000119107, 41333006, 419942003, 429860003, 431250008, 431496002, 431557005, 431613003, 431871005, 431892005, 432078003, 432770001, 433140006, 433141005, 443580006, 444634007, 448641007, 45554006, 46700000, 47987001, 48816001, 495741000119105, 571891000119109, 572091000119106, 57235004, 60443006, 61368000, 6238009, 66769009, 6728003, 68862002, 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, 72508000, 726546000, 772220000, 7812007, 79760008, 86392000, 90523008, 90805008, 91333005, 91583001, 17141000087101, 3731000087102, 3721000087104, 783627007

Uncomplicated Low Back Pain Value Set

ICD10CM:
M47.26, M47.27, M47.28, M47.816, M47.817, M47.818, M47.896, M47.897, M47.898, M48.06, M48.061, M48.062, 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, M99.43, 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:
100491000119103, 111633007, 113611000119100, 12242551000119102, 12242591000119107, 123534001, 123535000, 123798002, 12519004, 126963001, 128196005, 128197001, 129179000, 129501000119107, 13291000119100, 141481000119102, 15633361000119103, 15634631000119104, 15636531000119108, 15636571000119106, 15636611000119102, 15749221000119107, 15749261000119102, 15749301000119105, 15968741000119100, 15972821000119108, 161894002, 16206741000119104, 163241009, 163243007, 16650241000119101, 16650341000119107, 16839401000119104, 1684626100011910, 18347007, 19033007, 20021007, 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, 208084009, 208090008, 209086000, 209102002, 209169008, 209182000, 209185003, 209547009, 209548004, 209549007, 209550007, 209551006, 209552004, 209553009, 09559008, 209561004, 209565008, 209571002, 212192004, 212193009, 212218009, 212219001, 212220007, 212221006, 212222004, 212223009, 212224003, 212225002, 212226001, 212227005, 212457004, 23056005,, 230614002, 239880009, 2415007, 24300005, 247368002, 262726002. 262727006, 262731000, 262732007, 262736005, 262737001, 262742009, 262743004, 262747003, 262748008, 262995003, 263044008, 26538006, 267067009, 267982002, 274162005, 275316003, 278860009, 278862001, 279039007, 279040009, 279042001, 279063004, 281598004, 291941000119106, 291951000119108, 298251000, 298604007, 298605008, 298674008, 29885006, 29930001000004103, 299966003, 299967007, 300956001, 300957005, 301407002, 301408007, 301416003, 301417007, 307138004, 307176005, 307177001, 309710005, 311211000119105, 311804006, 313501000119105, 3200003, 322141000119100, 36241000119108, 363477002, 370471003, 38253002, 39058009, 405753002, 41455002, 416513001, 416546007, 416929004, 417056009, 417068000, 417098007, 417262009, 417414000, 417459008, 417614006, 417646006, 417685004, 417725008, 417731006, 417744001, 427027005, 427571000, 427923007, 448701000124105, 46578006, 46960006, 471000119102, 48210000, 54314008, 60937000, 61486003, 703619001, 713911007, 718929000, 718936004, 724899004, 735609006, 735610001, 735611002, 737254001, 764272007, 782661001, 86345004, 86814006, 87900003, 90631008, 9121000119106, 91240008, 92047003, 93743001, 94242004, 94782007

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 call 1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Technical Specs CPT® is a registered trademark of the American Medical Association.