Chances are that one out of every four patients you see in your office has low back pain. The Centers for Disease Control and Prevention (CDC) reports that in the last three months, 25% of U.S. adults report having low back pain, making it second only to the common cold as a cause for lost work time and a primary reason for a doctor’s visit.1  Back pain will usually go away on its own. About 90 percent of patients with low back pain recover within six weeks.2 For this reason, the National Committee for Quality Assurance (NCQA) recommends avoiding imaging for patients when there is no indication of an underlying condition. In a study published by the CDC, Early imaging for acute low back pain, the findings indicated not only was early imaging not associated with better outcomes, it also indicated that certain early imaging (MRI) was associated with an increased likelihood of disability and its duration.3

 

Watch this video to learn more

Take advantage of the Recommendation for Treating Acute Low Back Pain video located on the CDC website or use this link. The video also offers communications strategies to share with patients for effectively treating their low back pain.

 

HEDIS® measure: Use of Imaging Studies for Low Back Pain (LBP)

Description: The percentage of members 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. The higher compliance score indicates appropriate treatment of low back pain.

 

Exclusions include cancer, recent trauma, IV drug abuse, neurologic impairment, HIV, spinal infection, major organ transplant and prolonged use of corticosteroids.

 

Coding tips: Here are a few of the approved codes for the diagnosis and services associated with the LBP HEDIS measure. For a complete list, visit ncqa.org.

 

CPT or ICD-10

Code

Description

CPT

72010, 72020, 72052, 72100

Imaging study

ICD-10

M47.898

Other spondylosis, sacral and sacrococcygeal region

ICD-10

M48.08

Spinal stenosis, sacral and sacrococcygeal region

ICD-10

M53.2X8

Spinal instabilities, sacral and sacrococcygeal region

ICD-10

M54.40

Lumbago with sciatica, unspecified side

ICD-10

M51.26 – M51.27

Other intervertebral disc displacement, lumbar lumbosacral region

ICD-10

M54.30 – M54.32

Sciatica, unspecified, right side, left side

ICD-10

M51.16-M51.17

Intervertebral disc disorders with radiculopathy, lumbar region, lumbosacral region

ICD-10

M51.26-M51.27

Intervertebral disc displacement, lumbar region, lumbosacral region

ICD-10

M51.36-M51.37

Other intervertebral disc degeneration, lumbar region, lumbosacral region

ICD-10

M51.86-M51.87

Other intervertebral disc disorders, lumbar region, lumbosacral region

ICD-10

M99.53

Intervertebral disc stenosis of neural canal of lumbar region

ICD-10

S33.100A, S33.100D, S33.100S

Subluxation of unspecified lumbar vertebra; initial, subsequent, sequela encounter

ICD-10

S33.5XXA

Sprain of ligaments of lumbar spine; initial encounter

ICD-10

S33.6XXA

Sprain of sacroiliac joint; initial encounter

ICD-10

S33.8XXA

Sprain of other parts of lumbar spine and pelvis; initial encounter

ICD-10

S33.9XXA

Sprain of unspecified parts of lumbar spine and pelvis; initial encounter

ICD-10

S39.002A, S39.002D, S39.002S

Unspecified injury of muscle, fascia, and tendon of lower back; initial, subsequent, sequela encounter

ICD-10

S39.82XA, S39.82XD, S39.82XS

Other specified injuries of lower back; initial, subsequent, sequela encounter

 

1 https://www.cdc.gov/acute-pain/low-back-pain/index.html#:~:text=25%25%20of%20U.S.%20adults%20report,the%20most%20common%20pain%20reported.

2 https://abcnews.go.com/Health/CommonPainProblems/story?id=4047737#:~:text=Answer%3A%20Back%20pain%20usually %20goes,people%20recover%20faster%20than%20others

3 http://dx.doi.org/10.1097/BRS.0b013e318251887b

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

1180-0621-PN-NE

 



Featured In:
June 2021 Anthem Maine Provider News