Blue Review
A newsletter for contracting institutional and professional providers

August 2020

Imaging Studies for Uncomplicated Low Back Pain

The preferred conservative medical treatment for uncomplicated low back pain (LBP) is prescription-strength analgesics and physical therapy. Evidence does not support routine imaging for uncomplicated LBP. Severe LBP improves for most individuals within the first two weeks of onset. Imaging when not indicated may expose members to unnecessary radiation and expense.1

Healthcare Effectiveness Data and Information Set (HEDIS®) Measures for 2020-20212
One measure we collect for the National Committee for Quality Assurance (NCQA) evaluates the appropriate use of imaging studies for uncomplicated LBP.

This measure evaluates the percentage of members ages 18 to 50 diagnosed with LBP without the following:3

  • Prior diagnosis of LBP in the past six months
  • Imaging studies in the first 28 days [includes X-rays, Magnetic Resonance Imaging (MRI/MRA) and Computed Tomography (CT/CTA) scans] after diagnosis

Note: A higher percentage on this measure indicates better performance.

Associated Medical Conditions
Imaging within 28 days after diagnosis may be necessary if the member has other medical concerns. Examples of medical conditions that may require early imaging studies are listed in the chart below. You may want to document the medical condition and appropriate code when able to show the need for early imaging studies. Doing so will not affect your HEDIS score.

Early Imaging Exclusions

ICD-10 Codes

Cancer (active)

C00.0-96.Z and D00.00-49.9

Cancer (personal history) Z85-86.03

Corticosteroid Use (90 consecutive days)

During 12 months prior to LBP diagnosis

HIV B20; Z21
IV Drug Abuse F11.10-15.29 (any time during 12 months prior to LBP diagnosis)
History of Kidney Transplant (Kidney Transplant) Z94.0; (0TY00Z0-2, 0TY10Z0-2)
Organ Transplant Other Than Kidney 02YA0Z0-2, 07YM0Z0-2, 07YP0Z0-2, 0BYC0Z0-2, 0BYD0Z0-2, 0BYF0Z0-2, 0BYG0Z0-2, 0BYH0Z0-2, 0BYJ0Z0-2, 0BYK0Z0-2, 0BYL0Z0-2, 0BYM0Z0-2, 0DY50Z0-2, 0DY60Z0-2, 0DY80Z0-2, 0DYE0Z0-2, 0FY00Z0-2, 0FYG0Z0-2, 0UY00Z0-2, 0UY10Z0-2, 0UY90Z0-2, 0WY20Z0-1, 0XYJ0Z0-1, 0XYK0Z0-1, 3E030U1, 3E033U1, 3E0J3U1, 3E0J7U1, 3E0J8U1
Neurologic Impairment G83.4 (any time during 12 months prior to LBP diagnosis)
Spinal Infection, Osteomyelitis, and Discitis A17.81, G06.1, M46.25-46.28, M46.35-46.38, M46.46-46.48 (any time during 12 months prior to LBP diagnosis)
Trauma/Fractures G89.11; “S” series (any time during 3 months prior to LBP diagnosis)

Whom can I contact if I have questions?
If you have questions regarding the use of the HEDIS LBP measure with your Federal Employee Program® (FEP®) members or any other BCBSIL members, email Dr. Sonja Hughes.