DefinitionPercentage of claims with a primary diagnosis of low back pain (ICD-9 724.5 or 724.2) with an imaging procedure, as specified by CPT 72010-72120 (plain x-ray), 72125-72133 (CT scan), and 72141-72158 (MRI). A breakout of the percentage of claims with an MRI procedure is also provided.
NumeratorFor MRI graphical views - claims with an MRI 72141-72158 (MRI).
For all imaging graphical views - claims with any imaging procedure as defined by CPT 72010-72120 (plain x-ray), 72125-72133 (CT scan), and 72141-72158 (MRI).
DenominatorClaims with a primary diagnosis of low back pain (ICD-9 724.5 or 724.2).
Data Interpretation IssuesImaging procedures can be appropriate in cases of low back pain. As currently structured, this measure makes no attempt to determine if imaging was appropriate.
Why Is This Important?Most cases of low back pain eventually go away without significant medical intervention. The use of imaging procedures in these cases wastes money, needlessly increases exposure to radiation, and can lead to unnecessary surgery. This measure was primarily tabulated to focus further efforts on understanding potential geographic areas of imaging procedure overutilization.
Health Program InformationThe project described was supported by Funding Opportunity Number PR-PRP-13-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.