CQM Measure CMS166v6 Use of Imaging Studies for Low Back Pain

CQM Measure CMS166v6 Use of Imaging Studies for Low Back Pain

NQS Domain: Efficient Use of Healthcare Resources

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.

Denominator Logic

Patients in Age Range: >= 18 and < 50 years (checked one day before the start of the measurement period )

AND Patient had appointment A scheduled during measurement period, with CPT code [99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285] entered.

AND Patient had active patient problem Low Back Pain (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1001) recorded during measurement period. 

Denominator Exclusion Logic

 

OR Patient had active patient problem Low Back Pain (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1001) recorded <= 180 starts before appointment A

OR Patient had active patient problem All Cancer (CQM ValueSet: 2.16.840.1.113883.3.464.1003.108.12.1011) recorded before end of measurement period.

OR

        OR Patient had active patient problem Trauma (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1036) recorded during measurement period or <= 365 before the start of measurement period.
        OR Patient had active patient problem IV Drug Abuse (CQM ValueSet: 2.16.840.1.113883.3.464.1003.106.12.1003) recorded recorded during measurement period or <= 365 before the start of measurement period.
        OR Patient had active patient problem Neurologic impairment (CQM ValueSet: 2.16.840.1.113883.3.464.1003.114.12.1012) recorded during measurement period or <= 365 before the start of measurement period.

Numerator Logic

Patient did not have Lab Result X-Ray of Lower Spine (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1035) performed <= 28 days after appointment A

AND Patient did not have Lab Result MRI of Lower Spine (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1034) performed <= 28 days after appointment A

AND Patient did not have Lab Result CT Scan of Lower Spine (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1033) performed <= 28 days after appointment A

For more information, please visit the CMS website here. 

How To (Website)

Step 1: Order appropriate lab test as outlined in Numerator section

(Patient Record –Lab Orders -> New Order, within the appropriate specified time period per the numerator guidelines)

Step 2: When ordering the lab test, access the CQM Value Set tool to look up the appropriate term/code for the test you are ordering.  More information about how to access the CQM Value Set tool in drchrono can be found here.

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