eCQM: Use of Imaging Studies for Low Back Pain (CMS 166v6)

eCQM:

Use of Imaging Studies for Low Back Pain

CMS ID:

CMS 166v6

Measure Type:

Process

MIPS High Priority Measure:

Yes

Quality ID:

312

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Performance BEnchmark for MIPS:

100%

Description:

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.

  • Numerator: Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visit.
  • Denominator: Patients 18-50 years of age with a diagnosis of low back pain during an eligible outpatient visit (defined as a signed chart note with one of the following encounter types: Office Visit, Home Visit, Nurse Visit, or Nursing Home Visit) or emergency department visit during the first 337 days of the measurement period (337 days allows 28 days for the numerator event). This visit must be the first visit for low back pain during the measurement period.
    • Denominator Exclusions:

      • Patients with a diagnosis of cancer any time in their history or patients with a diagnosis of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to through the 28 days after the outpatient or emergency department visit.

      • Patients with a diagnosis of low back pain within the 180 days prior to the outpatient or emergency department visit.

    • Denominator Exceptions: None

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 166v6 Use of Imaging Studies for Low Back Pain are:

  • Initial patient population
  • Denominator
  • Numerator
  • Exclusion

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. Ensure that patients with low back pain have an appropriate diagnosis, with a start date, recorded in the medical record. Examples of low back pain diagnosis codes that can be used for this measure can be found in Table 1.

  2. Receive or record imaging results for imaging studies in the Practice Fusion EHR. CT scan, MRI and X-ray codes will be included in this measure when they are recorded using one of the following two options:

    1. Manually recorded as imaging results in the Practice Fusion EHR or received as structured imaging results from connected radiology centers. Refer to Table 1 for examples of codes that will be included from manually recorded imaging results and structured imaging results received from a connected radiology center.

    2. Entered in the Screenings/Interventions/Assessments section of the patient encounter. Refer to Table 2 for the suggested workflow to record the appropriate results in the Screenings/Interventions/Assessments section of the encounter.

Table 1: Examples of Coded Values that can be Recorded for CMS 166v6

Data Type

Example Codes

Low Back Pain Diagnosis Codes

  • Sciatica, unspecified side (ICD-10 M54.30)
  • Low back pain (ICD-10 M54.5)
  • Backache, unspecified (ICD-10 M54.9)

CT scan, MRI and X-ray Codes

  • Sacrum and Coccyx X-ray (LOINC 24665-2)
  • Spine Lumbar CT (LOINC 24963-1)
  • Spine Lumbar MRI (LOINC 24968-0)
  • Spine cervical and thoracic and lumbar MRI (LOINC 30854-4)
Table 2: Practice Fusion Suggested Workflow to Record Imaging Results in S/I/A

Data Type

Practice Fusion Suggested Workflow

Imaging Study

  • In the Screenings/Interventions/Assessments section of the encounter, search for an applicable CT scan, MRI or X-ray and select the item. Examples include:

    • Sacrum and Coccyx X-ray (LOINC 24665-2)

    • Spine Lumbar and Sacrum and Coccyx X-ray (LOINC 37341-5)

    • Lumbar spine MRI W contrast IV (LOINC 30678-7)

  • Record and save the following information in the modal window that opens:

    • Status: Performed

    • Start Date: Date the study was completed

To access a complete list of appropriate codes, visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.

Additional Measure Information

  • To be recognized for the denominator exclusion, the patient must meet the criteria detailed in Table 3.
  • To access a complete list of appropriate diagnosis codes, visit the United States Health Information Knowledgebase (USHIK).
  • The intent of this measure, per CMS specifications, is to minimize the ordering of imaging studies for patients with unspecified or nonspecific lower back pain. The numerator value for this measure is determined after a 28 day period following each relevant encounter, so you will not see any numerator values until at least 29 days after the encounter where the patient was diagnosed.

Table 3. Criteria for CMS 166v6 Denominator Exclusions

Data Element

Data Criteria

Cancer
(Diagnosis)

  • Diagnosis must have a start date during the 12-month period prior to through the 28 days after the outpatient or emergency department visit.

  • Examples of qualifying diagnosis codes:

    • C81.40 (ICD-10)

    • C86.1 (ICD-10)

Recent Trauma
(Diagnosis)

  • Diagnosis must have a start date during the 12-month period prior to through the 28 days after the outpatient or emergency department visit.

  • Examples of qualifying diagnosis codes:

    • S02.0XXA (ICD-10)

    • S02.63XD (ICD-10)

IV Drug Abuse
(Diagnosis)

  • Diagnosis must have a start date during the 12-month period prior to through the 28 days after the outpatient or emergency department visit.

  • Examples of qualifying diagnosis codes:

    • F11.10 (ICD-10)

    • F13.120 (ICD-10)

Neurologic Impairment
(Diagnosis)

  • Diagnosis must have a start date during the 12-month period prior to through the 28 days after the outpatient or emergency department visit.

  • Examples of qualifying diagnosis codes:

    • G83.4 (ICD-10)

    • M54.16 (ICD-10)

Low back pain
(Diagnosis)

  • Diagnosis must have a start date within the 180 days prior to the outpatient or emergency department visit.

  • Examples of qualifying diagnosis codes:

    • M46.46 (ICD-10)

    • M54.40 (ICD-10)

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