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 (Claims)

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.

Intake period - January 1–December 3 of the measurement year. The intake period is used to identify the first eligible encounter with a principal diagnosis of low back pain.

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

Uncomplicated Low Back Pain