Measure Title: Avoidance of Opiate Prescriptions for Low Back Pain or Migraines
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 (E/M Codes 99202-99205, 99212-99215, 99281- 99285, 99291-99292 AND Place of Service Indicator: 11, 19, 20, 22 or 23) PLUS
- Diagnosis of low back pain
- ICD-10: M54.50, M54.51, M54.59
OR
- 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, G43.709, 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
AND
- Disposition of Discharged
Numerator: Patients who were not prescribed an opiate (see Appendix A for list of opioidmedications)
Denominator Exclusions: Patients with active cancer, palliative care, end-of-life care.
Denominator Exceptions: Opiate prescribed for medical reason documented by the Eligible Professional (i.e., suspected or diagnosed herniated disk, fracture, sciatica, radiculopathy)
National Quality Forum (NQF) number, if applicable
N/A
Care setting(s)
Ambulatory; Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Ambulatory Care: Urgent Care; Emergency Department and Services; Hospital; Outpatient Services
Telehealth, if applicable
Yes
Number of performance rates required for measures
1
Traditional vs. inverse measure
Traditional
Proportional, continuous variable, and/or ratio measure indicator
Proportional
Risk adjustment, if applicable
No
Submission pathway
Traditional MIPS