Measure: 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 This measure is for use in the Medicaid EHR Incentive Program for Eligible Professionals only | ||
| Measure Type | High Priority Measure | Scoring |
| Process | Yes | A higher percentage indicates better quality |
| Denominator | Patients 18-50 years of age with a diagnosis of uncomplicated low back pain during a visit |
| Numerator | Patients without an imaging study conducted on the index episode start date or in the 28 days following the index episode start date |
| Denominator Exceptions | None |
| Denominator Exclusions | Exclude patients:
|
Denominator
Patients who meet the following criteria will be included in the denominator:
Age must be ≥ 18 years and < 50 years at the beginning of the Measurement Period
AND
- Must have an encounter finalized by the EP within the first 337 days of the Measurement Period during which they received a diagnosis for uncomplicated low back pain
Encounter Codes Eligible for Denominator
CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 98966, 98967, 98968, 98969, 99441, 99442, 99443, 99444, 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 99231, 99232, 99233, 99234, 99235, 99236, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99221, 99222, 99223, 99251, 99252, 99253, 99254, 99255, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99024, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337
HCPCS: G0402, G0438, G0439
Diagnosis
The patient must have a diagnosis of uncomplicated low back pain. A comprehensive list of eligible diagnosis codes for uncomplicated low back pain can be located here.
Denominator Exclusions
A patient will be excluded from this measure if they meet any of the following criteria:
- Had a diagnosis of HIV or cancer prior to or in the 28 days after the encounter in which they were diagnosed with uncomplicated low back pain
- Was diagnosed with uncomplicated low back pain in the 180 days before the encounter in which they were diagnosed with uncomplicated low back pain
- Had a major organ transplant performed prior to or in the 28 days after the encounter in which they were diagnosed with uncomplicated low back pain
- Had an active diagnosis of trauma in the 90 days prior to or in the 28 days after the encounter in which they were diagnosed with uncomplicated low back pain
- Had an active diagnosis of IV drug abuse, neurologic impairment, or spinal infection in the 12 months prior to or in the 28 days after the encounter in which they were diagnosed with uncomplicated low back pain
- Had an active prescription for corticosteroids for at least 90 days in the 12 months prior to the encounter in which they were diagnosed with uncomplicated low back pain
Patients who were in hospice care during the measurement year will also be excluded from the measure.
Diagnosis
Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for these exclusions can be located here.
Medication
To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > Prescribe a Medication. A comprehensive list of eligible corticosteroids can be located here.
Procedure Codes
To document a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add an eligible code. Order Status must be marked as Complete in order to count as an exclusion. A comprehensive list of eligible procedure codes for major organ transplant can be located here.
Hospice Care Services
To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:
SNOMED CT: 385763009, 385765002
Order Status must be marked as Complete.
Note
SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.
Numerator
A patient will be counted in the numerator if they did not receive an imaging study on the day of the encounter in which they were diagnosed with uncomplicated low back pain or in the 28 days after the encounter in which they were diagnosed with uncomplicated low back pain.
The imaging studies for uncomplicated low back pain counted for this measure are: MRI of the lower spine, CT scan of the lower spine, and X-ray of the lower spine.
eCQI Reference
Return to 2018 eCQMs