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COVID-19

Use of Imaging Studies for Low Back Pain (LBP)

HEDIS Measure

Use of Imaging Studies for Low Back Pain (LBP)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative

Measure Description

The percentage of members 18–75 years of age with a principal diagnosis of low back pain who did not have an imaging study (plain X- ray, MRI, CT scan) within 28 days of the diagnosis.

*Inverted Measure

Numerator Compliance

An imaging study with a diagnosis of uncomplicated low back pain on the IESD or in the 28 days following the IESD.

Index Episode Start Date = The earliest date of service for an eligible encounter during the Intake Period with a principal diagnosis of low back pain.

Quality Value Set Directory Coding Tips

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
  • M99.43
  • 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

  • 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