Aug. 04, 2020
Federal Employee Program (FEP) Members
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
When Not to Image
In general, members ages 18 to 50 should not undergo imaging studies for the first 28 days after LBP diagnosis if there is no prior diagnosis of LBP in the past six months.2
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. Document the medical condition and appropriate code when able to show the need for early imaging studies.
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 year prior to diagnosis of LBP |
HIV |
B20; Z21 |
IV Drug Abuse |
F11.10-15.29 (any time during year 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 |
Spinal Infection, Osteomyelitis, and Discitis |
A17.81, G06.1, M46.25-46.28, M46.35-46.38, M46.46-46.48 (any time during year prior to LBP diagnosis and 28 days after) |
Trauma/Fractures |
"S" series (any time during 3 months prior to LBP diagnosis) |
Whom can I contact with questions?
If you have questions with your Federal Employee Program (FEP) members, please contact Dr. Sonja Hughes at sonja_j_hughes@bcbsok.com.
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.
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1HEDIS measure for Use of Imaging Studies for Low Back Pain; accessed 6/1/2020
2NCQA HEDIS 2020 Technical specifications for health plans, volume 2, Washington DC, 2020