3/26/2015 Page 1. Detailed Criteria Field Name Dimen Table Name. Timeframe. Condition Description. Fact Table Name. # Evnt

Transcription

1 Measure : Low Back Pain Imaging Studies Owner: NCQA (LBP) Measure : LBP Lab Data: N Rule : The percentage of patients years of age who had a principal diagnosis of low back pain and who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of the diagnosis. Applicable Provider Specialty: Family practice, geriatricians (NM/TX), mixed specialty clinics, neurologists (NM/OK/TX), internal medicine, neurosurgeons (OK), orthopedic surgeons (OK/TX), emergency medicine (OK), and physical medicine/rehabilitation (OK) General Criteria Summary 1. Measurement period: 1 year prior to measurement period end date 2. Continuous enrollment: From 6 months (180 days) prior to the date of the index encounter through 28 days following the date of the index encounter 3. Anchor date: The earliest date of service for any outpatient or emergency department encounter with a principal diagnosis of low back pain 4. Gaps in enrollment: No gaps in the enrollment during the continuous enrollment period 5. Medical coverage: Yes 6. Drug coverage: No 7. Attribution time frame: 0-28 days post denominator event on low back pain visits 8. Exclusions apply: Yes 9. Age range: years Summary of changes for In the denominator the following codes were added: HCPCS codes G0463 and T1015. These are all outpatient visit types. 2. In the exclusions, numerous ICD-9 diagnosis codes were deleted because they all require additional digits to be valid codes. 3. We are no longer using room and board to identify ED visits that result in an inpatient admission, we are just using place of service Denominator : All patients, aged 18 years as of the beginning of the measurement period to 50 years as of the end of the measurement period, who had an outpatient or emergency department encounter with a principal diagnosis of low back pain Inclusion Criteria: Patients, aged 18 years as of the beginning of the measurement year to 50 years as of the end of the measurement year, who had at least one outpatient or emergency department encounter with a principal diagnosis of low back pain during the intake period, had no low back pain diagnosis during the six month (180 day) period prior to the first low back pain encounter, and had no diagnosis for which an imaging study in the presence of low back pain is clinically indicated. The intake period is from the beginning of the measurement year to 28 days prior to the end of the measurement year. Eligibility Criteria Condition Age is 18 years or older # Evnt Detailed Criteria Field Dimen Table Fact Table Timeframe Age in Years >= 18 age_years demog eligibility As of the beginning of measurement year Page 1

2 AND Age is 50 years or less Age in Years <= 50 age_years demog eligibility As of the end of the measurement year Claim Criteria Condition # Evnt Detailed Criteria Field Dimen Table Fact Table Timeframe At least one outpatient or observation visit with a principal diagnosis of low back pain 1 (dx must be on same claim as proc or rev code) ( Procedure = Outpatient, Observation Value Set Or HCPCS Procedure = Outpatient Value Set Or Revenue UB = Outpatient Value Set) proc_cd proc fac_dtl proc_cd proc fac_dtl fac_revenue_cd proc fac_dtl From the beginning of the measurement year to 28 days prior to the end of the measurement year And Diagnosis Principal = Low Back Pain Value Set dx_cd dx fac_hdr OR At least one emergency department visit with a principal diagnosis of low back pain (ED visit cannot be part of an admission) 1 (dx and place code must be on same claim as proc or rev code) ( Procedure = ED Value Set Or Revenue UB = ED Value Set) and Diagnosis Principal = Low Back Pain Value Set And proc_cd proc fac_dtl fac_revenue_cd proc fac_dtl dx_cd dx fac_hdr From the beginning of the measurement year to 28 days prior to the end of the measurement year OR Place of Service Medstat <> 21 mdst_place_cd clm_gener al fac_hdr At least one osteopathic Procedure = Osteopathic Manipulative Treatment Value Set proc_cd proc fac_dtl From the beginning of the measurement year to 28 days prior to the end of the measurement Page 2

3 manipulative visit with a principal diagnosis of low back pain And Diagnosis Principal = Low Back Pain Value Set dx_cd dx fac_hdr year Note: Identify all visits that meet the above criteria. Then select the encounter with the earliest date and use that as the index encounter before checking the remaining inclusion criteria. AND No low back pain diagnosis during the 6 month period prior to the date of the index encounter 1 All Diagnosis s <> Low Back Pain Value Set dx_cd dx any_dx fac_hdr From 6 months (180 days) prior to the date of the index encounter to the date of the index encounter Exclusion Criteria: Patients who had a diagnosis for which imaging is clinically appropriate. This includes cancer, recent trauma, intravenous drug abuse, or neurologic impairment. Condition Connector Condition # Evnt Field Dimen Table Fact Table Detailed Criteria Criteria Connector Timeframe AND No diagnosis of cancer, for which an imaging study in the presence of low back pain is clinically indicated No diagnosis of trauma, IV drug abuse, or neurologic impairment, for which an imaging study in the presence of low back pain is clinically indicated 1 dx_cd dx any_dx 1 dx_cd dx any_dx fac_hdr fac_hdr All Diagnosis s <> Malignant Neoplasms, Other Neoplasms, History of Malignant Neoplasms Value Set All Diagnosis s <> Trauma, IV Drug Abuse, Neurologic Impairment Value Set Anytime prior to through 28 days following the date of the index encounter From 12 months prior to the date of the index encounter through 28 days following the date of the index encounter Continuous Enrollment Criteria: Patients continuously enrolled with medical coverage from six months (180 days) prior to the date of the low back pain index encounter through 28 days following that date Condition # Evnt Detailed Criteria Field Dimen Table Fact Table Timeframe Continuous enrollment Continuous Enrollment is 208 days out of 208 days From 6 months (180 days) prior to the date of the index encounter through 28 days following the date of the index encounter Page 3

4 AND Has medical coverage Coverage Indicator Medical = Y medical_covg_ind plan eligibility From 6 months (180 days) prior to the date of the index encounter through 28 days following the date of the index encounter Numerator : For each patient who meets the denominator criteria, those who did not receive an imaging study for low back pain on the date of the index encounter or in the 28 days following that date Inclusion Criteria: Patients who did not have an imaging study for low back pain during the period from the date of the index encounter through 28 days following the date of the index encounter Condition No spinal imaging study performed at all # Evnt Detailed Criteria Field Dimen Table Fact Table 1 Procedure <> Imaging Studies Value Set proc_cd proc fac_dtl and Revenue UB <> Imaging Studies Value Sets fac_revenue_cd proc fac_dtl Timeframe During the 29 day period from the date of the index encounter through 28 days following the date of the index encounter OR No spinal imaging study performed for low back pain 1 (dx code must be on same claim as proc code or rev ( Procedure = Imaging Studies Value Set proc_cd proc fac_dtl or Revenue UB = Imaging Studies Value Set) fac_revenue_cd proc fac_dtl and All Diagnosis s <> Low Back Pain Value Set dx_cd dx any_dx fac_hdr During the 29 day period from the date of the index encounter through 28 days following the date of the index encounter Notes: 1. In the denominator criterion that looks for at least one outpatient or emergency department encounter, a Place of Service criterion is not needed for the procedure codes or revenue codes because they are setting-specific. 2. For all criteria based on facility header attributes, the Date of First Service from the facility claim is used to determine whether the criteria falls within the indicated timeframe, unless otherwise specified. For outpatient claims, this is the service date. For inpatient claims, this is the admission date. 3. The intake period is 28 days less than a full year. For example, if the measurement year starts on January 1, the intake period runs from January 1 through December 3. Page 4

5 4. The numerator is split into three components so that we can capture both patients who did not have a spinal imaging study at all and patients who had a spinal imaging study for something other than low back pain. The criteria that looks for no imaging study performed at all is split into two separate criterion because the code and revenue code do not necessarily need to be on the same claim. 5. In their 2010/2011 specs, NCQA removed revenue code 077* from the list of codes for outpatient visit types. 6. In their 2010/2011 specs, NCQA added diagnosis code 209* to the list of codes for cancer exclusions. 7. In 2012, ICD-9 Diagnosis code was added to Table LBP-A. 8. Do not include ED visits that result in an inpatient admission. 9. In their 2014 specs, NCQA replaced all coding table references with value set references. The following changes were made in the denominator: Added codes , 99387, , and (visit types); and, added HCPCS codes G0402, G0438, and G0439 (visit types). While Place of Service codes are not referenced by NCQA, we will keep these codes in order to eliminate ED visits that result in an admission. 10. In their 2014 specs, NCQA now calls out the exclusions as such, rather than including the exclusionary criteria as part of the denominator. 11. We are correcting a timeframe error in the cancer exclusion, from Anytime prior to or during the measurement year to Anytime prior to through 28 days following the date of the index encounter. 12. In 2015: a. NCQA added the following codes to the denominator: HCPCS codes G0463 and T1015. These are all outpatient visit types. b. In the exclusions, numerous ICD-9 diagnosis codes were deleted because they all require additional digits to be valid codes. c. We are no longer using room and board to identify ED visits that result in an inpatient admission, we are just using place of service. Appendix Low Back Pain Value Set Type ICD-9-CM Diagnosis Lumbosacral spondylosis without myelopathy ICD-9-CM Diagnosis Displacement of lumbar intervertebral disc without myelopathy ICD-9-CM Diagnosis Schmorl's nodes of lumbar region ICD-9-CM Diagnosis Degeneration of lumbar or lumbosacral intervertebral disc ICD-9-CM Diagnosis Other and unspecified disc disorder of lumbar region ICD-9-CM Diagnosis Spinal stenosis, lumbar region, without neurogenic claudication ICD-9-CM Diagnosis Spinal stenosis, lumbar region, with neurogenic claudication ICD-9-CM Diagnosis Lumbago Page 5

6 724.3 ICD-9-CM Diagnosis Sciatica ICD-9-CM Diagnosis Backache unspecified ICD-9-CM Diagnosis Disorders of sacrum ICD-9-CM Diagnosis Unspecified disorder of coccyx ICD-9-CM Diagnosis Hypermobility of coccyx ICD-9-CM Diagnosis Other disorders of coccyx ICD-9-CM Diagnosis Other acquired deformity of back or spine ICD-9-CM Diagnosis Nonallopathic lesions of lumbar region not elsewhere classified ICD-9-CM Diagnosis Nonallopathic lesions of sacral region not elsewhere classified ICD-9-CM Diagnosis Lumbosacral (joint) (ligament) sprain ICD-9-CM Diagnosis Sacroiliac (ligament) sprain ICD-9-CM Diagnosis Sacrospinatus (ligament) sprain ICD-9-CM Diagnosis Sacrotuberous (ligament) sprain ICD-9-CM Diagnosis Other specified sites of sacroiliac region sprain ICD-9-CM Diagnosis Unspecified site of sacroiliac region sprain ICD-9-CM Diagnosis Lumbar sprain Osteopathic Manipulative Treatment Value Set Type Osteopathic manipulative treatment Spinal manipulative treatment Outpatient Value Set Type New patient, office or other outpatient service Established patient, office or other outpatient service Office or other outpatient consultations, New or established patient Home services, New patient Home services, Established patient Init Pm E/M - New Pat - Inf Init Pm E/M - New Pat 1-4 Yrs Prev Visit - New - Age 5-11 Page 6

7 Preventive medicine services, years, new patient Per Pm Reeval - Est Pat - Inf Prev Visit - Est - Age Prev Visit - Est - Age Preventive medicine services, years, established patient Preventive medicine, individual counseling, new or established, 15 min Preventive medicine, individual counseling, new or established, 30 min Preventive medicine, individual counseling, new or established, 45 min Preventive medicine, individual counseling, new or established, 60 min Preventive medicine, group counseling, 30 min Preventive medicine, group counseling, 60 min Other preventive medicine services, administration and interpretation Other preventive medicine services, unlisted 99455, Work related or medical disability evaluation services G0402 HCPCS Initial preventive physical; f-f visit, new G0438 HCPCS Annual wellness visit; personalized prevention plan, initial G0439 HCPCS Annual wellness visit; personalized prevention plan, subsequent G0463 HCPCS Hospital outpatient clinic visit for assessment and management of a patient T1015 HCPCS All-inclusive clinic visit 0510 CLINIC 0511 CHRONIC PAIN CL 0512 DENTAL CLINIC 0513 PSYCH CLINIC 0514 OB-GYN CLINIC 0515 PEDS CLINIC 0516 URGENT CLINIC 0517 FAMILY CLINIC 0519 OTHER CLINIC 0520 FREESTAND CLINIC 0521 RURAL/CLINIC 0522 RURAL/HOME 0523 FR/STD FAMILY CLINIC 0526, 0527, 0528 FR/STD URGENT CLINIC 0529 OTHER FR/STD CLINIC 0982 PRO FEE/OUTPT 0983 PRO FEE/CLINIC Page 7

8 Observation Value Set Type Observation Care Discharge Observation Care ED Value Set Type Emergency services, new or established patient 0450 EMERG ROOM 0451 ER/EMTALA 0452 ER/BEYOND EMTALA 0456 URGENT CARE 0459 OTHER EMER ROOM 0981 PRO FEE/ER Malignant Neoplasms Value Set Type 140.0, 140.1, , 140.8, ICD-9-CM Diagnosis Malignant neoplasm of lip , 141.8, ICD-9-CM Diagnosis Malignant neoplasm of tongue , 142.8, ICD-9-CM Diagnosis Malignant neoplasm of major salivary glands 143.0, 143.1, 143.8, ICD-9-CM Diagnosis Malignant neoplasm of gum 144.0, 144.1, 144.8, ICD-9-CM Diagnosis Malignant neoplasm of floor of mouth , 145.8, ICD-9-CM Diagnosis Malignant neoplasm of other and unspecified parts of mouth ICD-9-CM Diagnosis Malignant neoplasm of oropharynx , 147.8, ICD-9-CM Diagnosis Malignant neoplasm of nasopharynx , 148.8, ICD-9-CM Diagnosis Malignant neoplasm of hypopharynx 149.0, 149.1, 149.8, ICD-9-CM Diagnosis Malignant neoplasm of other and ill-defined sites with in the kip, oral cavity, and pharynx , 150.8, ICD-9-CM Diagnosis Malignant neoplasm of esophagus , 151.8, ICD-9-CM Diagnosis Malignant neoplasm of stomach , 152.8, ICD-9-CM Diagnosis Malignant neoplasm of small intestine, including duodenum ICD-9-CM Diagnosis Malignant neoplasm of colon , ICD-9-CM Diagnosis Malignant neoplasm of rectum, rectosigmoid junction, and anus ICD-9-CM Diagnosis Malignant neoplasm of liver and interhepatic bile ducts , 156.8, ICD-9-CM Diagnosis Malignant neoplasm of gallbladder and extrahepatic bile ducts Page 8

9 , 157.8, ICD-9-CM Diagnosis Malignant neoplasm of pancreas 158.0, 158.8, ICD-9-CM Diagnosis Malignant neoplasm of retroperitoneum and peritoneum 159.0, 159.1, 159.8, ICD-9-CM Diagnosis Malignant neoplasm of other/ill-defined sites within the digestive organs and peritoneum , 160.8, ICD-9-CM Diagnosis Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses , 161.8, ICD-9-CM Diagnosis Malignant neoplasm of larynx 162.0, , 162.8, ICD-9-CM Diagnosis Malignant neoplasm of trachea, bronchus, and lung 163.0, 163.1, 163.8, ICD-9-CM Diagnosis Malignant neoplasm of pleura , 164.8, ICD-9-CM Diagnosis Malignant neoplasm of thymus, heart, and mediastinum 165.0, 165.8, ICD-9-CM Diagnosis Malignant neoplasm of other ill-defined sites within respiratory system/intrathoracic organs ICD-9-CM Diagnosis Malignant neoplasm of bone and articular cartilage 171.0, ICD-9-CM Diagnosis Malignant neoplasm of connective and other soft tissue ICD-9-CM Diagnosis Malignant melanoma of skin , , , ICD-9-CM Diagnosis Other and unspecified malignant neoplasm of the skin , , , , , , , , 174.8, ICD-9-CM Diagnosis Malignant neoplasm of female breast 175.0,175.9 ICD-9-CM Diagnosis Malignant neoplasm of male breast , 176.8, ICD-9-CM Diagnosis Kaposi's sarcoma 179 ICD-9-CM Diagnosis Malignant neoplasm of uterus-part unspecified 180.0, 180.1, 180.8, ICD-9-CM Diagnosis Malignant neoplasm of cervix uteri 181 ICD-9-CM Diagnosis Malignant neoplasm of placenta 182.0, 182.1, ICD-9-CM Diagnosis Malignant neoplasm of body of uterus 183.0, , 183.8, ICD-9-CM Diagnosis Malignant neoplasm of ovary and other uterine adnexa , 184.8, ICD-9-CM Diagnosis Malignant neoplasm of other and unspecified female genital organs 185 ICD-9-CM Diagnosis Malignant neoplasm of prostate 186.0, ICD-9-CM Diagnosis Malignant neoplasm of testis ICD-9-CM Diagnosis Malignant neoplasm of penis and other male genital organs ICD-9-CM Diagnosis Malignant neoplasm of bladder , 189.8, ICD-9-CM Diagnosis Malignant neoplasm of kidney and other and unspecified urinary organs ICD-9-CM Diagnosis Malignant neoplasm of eye ICD-9-CM Diagnosis Malignant neoplasm of brain , 192.8, ICD-9-CM Diagnosis Malignant neoplasm of other and unspecified parts of the nervous system 193 ICD-9-CM Diagnosis Malignant neoplasm of thyroid gland 194.0, , 194.8, ICD-9-CM Diagnosis Malignant neoplasm of other endocrine glands and related structures , ICD-9-CM Diagnosis Malignant neoplasm of other and ill-defined sites , 196.5, 196.6, 196.8, ICD-9-CM Diagnosis Secondary and unspecified malignant neoplasm of lymph nodes Page 9

10 ICD-9-CM Diagnosis Secondary malignant neoplasm of respiratory and digestive systems , , , ICD-9-CM Diagnosis Secondary malignant neoplasm of other specified sites ICD-9-CM Diagnosis Malignant neoplasm without specification of site , , , ICD-9-CM Diagnosis Lymphosarcoma/reticulosarcoma and other specified malignant tumors of lymphatic tissue , , , , , , , , ICD-9-CM Diagnosis Hodgkin's disease , , , , , , , ICD-9-CM Diagnosis Other malignant neoplasms of lymphoid and histiocytic tissue , , , , , , , , ICD-9-CM Diagnosis Multiple myeloma and immunoproliferative neoplasms , , , ICD-9-CM Diagnosis Lymphoid leukemia , , , , ICD-9-CM Diagnosis Myeloid leukemia , , , , ICD-9-CM Diagnosis Monocytic leukemia , , , , ICD-9-CM Diagnosis Other specified leukemia , , , ICD-9-CM Diagnosis Leukemia of unspecified cell type , , , , , , , , , ICD-9-CM Diagnosis Neuroendocrine tumors Other Neoplasms Value Set Type ICD-9-CM Diagnosis Carcinoma in situ of digestive organs ICD-9-CM Diagnosis Carcinoma in situ of respiratory system ICD-9-CM Diagnosis Carcinoma in situ of skin , , , ICD-9-CM Diagnosis Carcinoma in situ of breast and genitourinary system , 234.8, ICD-9-CM Diagnosis Carcinoma in situ of other and unspecified sites ICD-9-CM Diagnosis Neoplasm of uncertain behavior of digestive and respiratory systems , , , ICD-9-CM Diagnosis Neoplasm of uncertain behavior of genitourinary organs Page 10

11 , , , ICD-9-CM Diagnosis Neoplasm of uncertain behavior of endocrine glands and nervous system , , , 238.8, ICD-9-CM Diagnosis Uncertain behavior of neoplasm of bone , , , ICD-9-CM Diagnosis Neoplasm NOS History of Malignant Neoplasm Value Set V10.00-V10.07, V10.09, V10.11, V10.12, V V10.22, V10.29, V10.3, V10.40-V10.53, V V10.62, V10.69-V10.72, V10.79, V10.81-V10.91 Type ICD-9-CM Diagnosis Personal history of malignant neoplasm IV Drug Abuse Value Set Type 304.0, ICD-9-CM Diagnosis Opioid type dependence 304.1, ICD-9-CM Diagnosis sedative, hypnotic or anxiolytic dependence 304.2, ICD-9-CM Diagnosis Cocaine dependence ICD-9-CM Diagnosis Amphetamine and other psychostimulant dependence 305.4, ICD-9-CM Diagnosis Nondependent sedative, hypnotic or anxiolytic abuse 305.5, ICD-9-CM Diagnosis Nondependent opioid abuse 305.6, ICD-9-CM Diagnosis Nondependent cocaine abuse 305.7, ICD-9-CM Diagnosis Nondependent amphetamine or related acting sympathomimetic abuse Neurologic Impairment Value Set Type ICD-9-CM Diagnosis Cauda equina syndrome NOS ICD-9-CM Diagnosis Neuralgia/neuritis NOS Trauma Value Set , , , , , , , Type ICD-9-CM Diagnosis : Trauma Fracture of vault of skull Page 11

12 , , , , , , ICD-9-CM Diagnosis Fracture of base of skull , , , , , , , , 802.1, , ICD-9-CM Diagnosis Fracture of face bones , , , ICD-9-CM Diagnosis Other and unqualified skull fractures , , , , , , , , , , ICD-9-CM Diagnosis Multiple fractures involving skull or face with other bones , , , , , , , , , ICD-9-CM Diagnosis Fracture of vertebral column without mention of spinal cord injury , 806.4, 806.5, , ICD-9-CM Diagnosis Fracture of vertebral column with spinal cord injury , , 806.8, , ICD-9-CM Diagnosis Fracture of rib(s) sternum larynx and trachea , , , , ICD-9-CM Diagnosis Fracture of pelvis , 808.8, , ICD-9-CM Diagnosis Ill-defined fractures of bones of trunk , ICD-9-CM Diagnosis Fracture of clavicle , , ICD-9-CM Diagnosis Fracture of scapula , , , , ICD-9-CM Diagnosis Fracture of humerus , , , , , , , ICD-9-CM Diagnosis Fracture of radius and ulna , , , , ICD-9-CM Diagnosis Fracture of carpal bone(s) , , ICD-9-CM Diagnosis Fracture of metacarpal bone(s) , ICD-9-CM Diagnosis Fracture of one or more phalanges of hand 817.0, ICD-9-CM Diagnosis Multiple fractures of hand bones 818.0, ICD-9-CM Diagnosis Ill-defined fractures of upper limb 819.0, ICD-9-CM Diagnosis Multiple fractures involving both upper limbs and upper limb with rib(s) and sternum , , , ICD-9-CM Diagnosis Fracture of neck of femur , 820.8, , , , , , ICD-9-CM Diagnosis Fracture of other and unspecified parts of femur , , ICD-9-CM Diagnosis Fracture of patella , , , , , , , , ICD-9-CM Diagnosis Fracture of tibia and fibula ICD-9-CM Diagnosis Fracture of ankle Page 12

13 825.0, 825.1, , , ICD-9-CM Diagnosis Fracture of one or more tarsal and metatarsal bones 826.0, ICD-9-CM Diagnosis Fracture of one or more phalanges of foot 827.0, ICD-9-CM Diagnosis Other multiple and ill-defined fractures of lower limb 828.0, ICD-9-CM Diagnosis Multiple fractures involving both lower limbs lower with upper limb and lower limb(s) with rib(s) and 829.0, ICD-9-CM Diagnosis sternum Fracture of unspecified bones 830.0, ICD-9-CM Diagnosis Dislocation of jaw , ICD-9-CM Diagnosis Dislocation of shoulder , , , ICD-9-CM Diagnosis Dislocation of elbow , , ICD-9-CM Diagnosis Dislocation of wrist , ICD-9-CM Diagnosis Dislocation of finger , ICD-9-CM Diagnosis Dislocation of hip , , , ICD-9-CM Diagnosis Dislocation of knee 837.0, ICD-9-CM Diagnosis Dislocation of ankle , , ICD-9-CM Diagnosis Dislocation of foot , , , , , , , , , , , , , 839.8, ICD-9-CM Diagnosis Other multiple and ill-defined dislocations 850.0, , , , ICD-9-CM Diagnosis Concussion , , , , , , , , , , , ICD-9-CM Diagnosis Cerebral laceration and contusion , , , , , , ICD-9-CM Diagnosis Subarachnoid subdural and extradural hemorrhage following injury , , ICD-9-CM Diagnosis Other and unspecified intracranial hemorrhage following injury , , ICD-9-CM Diagnosis Intracranial injury of other and unspecified nature ICD-9-CM Diagnosis Traumatic pneumothorax and hemothorax , , , ICD-9-CM Diagnosis Injury to heart and lung , 862.1, , , , , , , 862.8, ICD-9-CM Diagnosis Injury to other and unspecified intrathoracic organs 863.0, 863.1, , , , , , , , , ICD-9-CM Diagnosis , , ICD-9-CM Diagnosis Injury to liver Injury to gastrointestinal tract , , ICD-9-CM Diagnosis Injury to spleen , ICD-9-CM Diagnosis Injury to kidney Page 13

14 ICD-9-CM Diagnosis Injury to pelvic organs , , ICD-9-CM Diagnosis Injury to other intra-abdominal organs 869.0, ICD-9-CM Diagnosis Internal injury to unspecified or ill-defined organs ICD-9-CM Diagnosis Late effects of musculoskeletal and connective tissue injuries ICD-9-CM Diagnosis Late effects of injuries to skin and subcutaneous tissues ICD-9-CM Diagnosis Late effects of injuries to the nervous system , ICD-9-CM Diagnosis Late effects of other and unspecified injuries , ICD-9-CM Diagnosis Late effects of other and unspecified external causes ICD-9-CM Diagnosis Crushing injury of back ICD-9-CM Diagnosis Crushing injury of buttock 929.0, ICD-9-CM Diagnosis Crushing injury of multiple and unspecified sites , , 952.8, ICD-9-CM Diagnosis Spinal cord injury without evidence of spinal bone injury , , ICD-9-CM Diagnosis Certain early complications of trauma , , , , ICD-9-CM Diagnosis Injury other and unspecified Imaging Studies Value Set 72010, , 72110, 72114, , Type X-ray exam of spine X-ray exam of neck spine X-ray exam of lower spine Ct lumbar spine w/o dye Ct lumbar spine w/dye Ct lumbar spine w/o & w/dye MRI neck spine w/o dye MRI neck spine w/dye MRI chest spine w/o dye MRI chest spine w/dye MRI lumbar spine w/o dye MRI lumbar spine w/dye MRI neck spine w/o & w/dye MRI lumbar spine w/o & w/dye X-ray exam sacroiliac joints Page 14

15 X-ray exam of sacrum and coccyx Radiology - Diagnostic Other Computerized Tomography (CT Scan) Body scan Other CT scans Magnetic Resonance Imaging (MRI) MRI spinal cord (including spine) MRI other Other Radiology diagnostic Page 15