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Important Facts for Lower Back Pain with Imaging Procedures

Definition

Percentage 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.

Numerator

For 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).

Denominator

Claims with a primary diagnosis of low back pain (ICD-9 724.5 or 724.2).

Data Interpretation Issues

Imaging 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 Information

The 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.
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 19 January 2018 14:23:57 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Tue, 20 Dec 2016 15:48:04 MST