2021 ECPR46: Avoidance of Opiates for Low Back Pain or Migraines

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