Measure Description
Percentage of Patients with Low Back Pain and/or Migraines Who Were Not Prescribed an Opiate
Denominator
- Any patient ≥ 18 years of age evaluated by the Eligible Professional in the Emergency Department or Urgent Care Clinic (E/M Codes 99201-99205, 99212-99215, 99281- 99285, 99291-99292 AND Place of Service Indicator: 11, 19, 20, 22 or 23) PLUS
- Diagnosis of low back pain OR
- ICD-10: M54.5
- Diagnosis of migraine ICD-10: G43.001, G43.009, G43.011, G43.019, G43.101, G43.109, G43.111, G43.119, G43.401, G43.409, G43.411, G43.419, G43.501, G43.509, G43.511, G43.519, G43.601, G43.609, G43.611, G43.619, G43.701, 43.709, G43.711, G43.719, G43.A0, G43.A1, G43.B0, G43.B1, G43.C0, G43.C1, G43.D0, G43.D1, G43.801, G43.809, G43.811, G43.819, G43.821, G43.829, G43.831, G43.839, G43.901, G43.909, G43.911, G43.919 PLUS
- Disposition of Discharged
Numerator
Patients who were not prescribed an opiate
Numerator Options:
- Performance Met (VE263): Opiate not prescribed
- Medical Performance Exclusion (Denominator Exception) (VE264): Opiate prescribed for medical reason documented by the Eligible Professional (e.g., headache pain refractory to other medications, severe headache, suspected or diagnosed herniated disk, fracture, sciatica, radiculopathy)
- Performance Not Met (VE265): Opiate prescribed, reason not specified
Numerator Exclusions
None
NQF ID Number
N/A
NQS Domain
Effective Clinical Care
High Priority Measure
Yes
Includes Telehealth?
Yes
Inverse Measure
No
Proportional Measure
Yes
Continuous Variable Measure
No
Ratio Measure
No
Number of performance rates to be calculated and submitted
1
Risk-Adjusted Status?
No
Meaningful Measure
Prevention and Treatment of Opioid and Substance Use Disorders
Measure Type
Process
Care Settings
Multiple Care Settings