In This Issue:

HIP Service Area Expansion Affects GHI HMO Providers

New Prior Approval List

New Web Usage Requirements for GHI HMO Network Providers

New EmblemHealth Radiation Therapy Program and EmblemHealth Cardiology Imaging Program and HIP Radiology Programs Apply to More Members

Updated Fax Forms for: EmblemHealth Injectable Drug Utilization Management Program

EmblemHealth Consolidates Post Office Boxes for GHI HMO and EmblemHealth Medicare PPO

Claims Corner

Medicaid and Medicare Updates

Behind the Scenes

Case Management Programs

Stressing the Importance of Prenatal Visits

Well-Child Visits

High-Risk Medications for Elderly Patients

Healthful Aging Starts With Lifestyle Changes and Preventive Screenings

Talking With Patients About Urinary Incontinence

Treating Rheumatoid Arthritis

Assisting Patients Living With HIV

Treating Low Back Pain

Asthma Management

CPT Codes for Tobacco Cessation Counseling

Clinical Corner

News&Notes Archive

Treating Low Back Pain

Low back pain is the fifth most common reason for all physician visits and the second most common affliction after the common cold. Low back pain disables 5.4 million Americans and costs at least $90 billion each year in medical and non-medical expenses per year.1

Conservative Treatment
Low back pain diagnoses are generally determined through medical history and a physical exam and rarely require expensive or uncomfortable tests. Exercise, physical therapy, medication, rest and application of heat or cold are effective therapies for low back pain. If these therapies are ineffective, X-rays, MRIs and other diagnostic tests are appropriate alternatives. In some instances, these tests may be a first line of treatment, but such cases represent a small fraction of low back pain diagnoses.

In their Choosing Wisely campaign to educate patients and providers, the American Academy of Family Physicians recommends the following:

  • No imaging for low back pain within the first six weeks, unless the following red flags are present:
    • Severe or progressive neurological deficits
    • Suspected serious underlying conditions such as osteomyelitis2
  • Imaging of the lower spine before six weeks. This procedure does not improve outcomes but does increase costs and involve unnecessary radiation exposure.

Please refer to our clinical practice guidelines (CPG) for low back pain diagnosis and treatment management. Call 1-888-447-5451 to request a paper copy of this or any specific CPG.


1American College of Rheumatology. 2012. “Back Pain.”

2American Academy of Family Physicians. 2012. "Choosing Wisely Campaign Aims to Cut Use of Unnecessary Medical Interventions."

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