April 5, 2019
At Blue Cross and Blue Shield of Texas (BCBSTX), we are committed to offering support and resources to physicians to achieve the highest level of care possible for their patients. Thank you for your dedication to ensure that your patients receive exceptional care.
The National Committee for Quality Assurance (NCQA) developed and maintains the Healthcare Effectiveness Data and Information Set® (HEDIS) to standardize and measure quality for all patients. One of these measures looks at using imaging studies for uncomplicated new onset lower back pain. The intent is to evaluate the appropriate use of all diagnostic imaging studies, including x-rays for this condition. Generally, patients with new onset low back pain diagnosis should not receive any imaging within the first 30 days of diagnosis, but rather receive conservative medical treatment with prescription strength analgesics and physical therapy.
NCQA realizes that each patient’s presentation is unique, and imaging may be required, and has therefore added a vast number of medical conditions where imaging could be considered medically necessary on initial patient presentation. If you have such a situation and simply provide that additional diagnosis in your medical evaluation, then your patient with low back pain is excluded from your HEDIS metric and does not negatively affect your performance for NCQA.
Below we have provided a chart for your review and easy access, to utilize during your low back pain patient visits. We hope this provides one less step in your daily process to evaluate your patients.