Use of Imaging Studies for
Low Back Pain (LBP)
Q: Which members are included in the sample?
A: Members 18-50 years of age 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.
Q: What codes are used?
A: Please reference attached sample codes and Value Set Directory for additional codes
Q: What documentation is needed in the medical record?
A: None. This measure requires claim/encounter data submission only using the appropriate Value Set Codes.
Q: What type of document is acceptable?
A: Evidence from claim/encounter
• Imaging study with diagnosis of low back pain on the IESD or in the 28 days following the IESD.
Index Episode Start Date (IESD): The earliest date of service for an outpatient or ED encounter during the
Intake Period (January 1, 2016 – December 3, 2016) with a principal diagnosis of low back pain.
Q: How to improve score for this HEDIS measure?
A:
;Use of complete and accurate Value Set Codes
;Timely submission of claims and encounter data
;Proper coding or documentation of any of the following diagnoses for which imaging is clinically
appropriate – to assist in excluding members from the HEDIS sample. See below for exclusion criteria.
Exclusions : (Use designated Value Set for each)
Any of the following meet criteria:
• Cancer • HIV
• Recent Trauma • Spinal infection
• Intravenous drug abuse • Major organ transplant
• Neurologic impairment • Prolonged use of corticosteroids
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