Age must be 17 or over with a diagnostic code for diabetes mellitus
Neuropathy testing codes (Added in the last 15 months)
- 66Aq. Diabetic foot screen (v13)
- 311A. Monofilament foot sensation test
- 29B7. 10g monofilament sensation present
- 29B8. 10g monofilament sensation absent
- 29B9. 10g monofilament sensation R foot abnormal
- 29BA. 10g monofilament sensation L foot abnormal
- 29BB. 10g monofilament sensation R foot normal
- 29BC. 10g monofilament sensation L foot normal
29BD. 10g monofilament sensation plantar aspect of great toe left foot present
(v12)
29BE. 10g monofilament sensation plantar aspect of middle toe right foot present
(v12)
29BF. 10g monofilament sensation plantar aspect of middle toe left foot present
(v12)
29BG. 10g monofilament sensation plantar aspect of little toe right foot present
(v12)
29BH. 10g monofilament sensation plantar aspect of little toe left foot present
(v12)
29BJ. 10g monofilament sensation plantar aspect of first metatarsal head right
foot present (v12)
29BK. 10g monofilament sensation plantar aspect of first metatarsal head left
foot present (v12)
29BL. 10g monofilament sensation plantar aspect of great toe right foot present
(v12)
29BM. 10g monofilament sensation plantar aspect of great toe right foot absent
(v12)
29BN. 10g monofilament sensation plantar aspect of great toe left foot absent
(v12)
29BP. 10g monofilament sensation plantar aspect of middle toe right foot absent
(v12)
29BQ. 10g monofilament sensation plantar aspect of middle toe left foot absent
(v12)
29BR. 10g monofilament sensation plantar aspect of little toe right foot absent
(v12)
29BS. 10g monofilament sensation plantar aspect of little toe left foot absent
(v12)
29BT. 10g monofilament sensation plantar aspect of first metatarsal head right
foot absent (v12)
29BV. 10g monofilament sensation plantar aspect of first metatarsal head left
foot absent (v12)
- 29B1. O/E - tactile sensation normal
- 29B2. O/E - anaesthesia present
- 29B20 O/E - anaesthesia in legs
- 29B21 O/E - anaesthesia of extremities
- 29B3. O/E - hypoaesthesia present
- 29H1. O/E - vibration sense normal
- 29H2. O/E - vibration sense reduced
- 29H3. O/E - vibration sense absent
- 29H4. O/E - Vibration sense of right foot abnormal
- 29H5. O/E - Vibration sense of right foot normal
- 29H6. O/E - Vibration sense of left foot abnormal
- 29H7. O/E - Vibration sense of left foot normal
- 29H8. O/E - vibration sense left foot reduced
- 29H9. O/E - vibration sense right foot reduced
- 29HA. O/E - Vibration sense of right foot absent
- 29HB. O/E - Vibration sense of left foot absent
- 66Ac. Diabetic peripheral neuropathy screening
- 9NND. Under care of diabetic foot screener
- 8H7r. Refer to diabetic foot screener
-
Foot examination exception codes (Added in the last 15 months)
- 8I6G. Diabetic foot examination not indicated
- 8I3W. Diabetic foot examination declined
- 8IAo. Foot pulse check declined (v18)
- 8IB6. Patient unsuitable for foot pulse check (v18)
- 8IAn. Neuropathy assessment declined (v18)
- 8IB5. Patient unsuitable for neuropathy assessment
(v18)
Diabetes exception reporting codes
(Added in the last 15 months)
- 9h4.. Exception reporting: diabetes quality indicators
- 9h41. Excepted from diabetes quality indicators: Patient
unsuitable
- 9h42. Excepted from diabetes quality indicators: Informed
dissent
9h43. Excepted from diabetes quality indicators:
service unavailable (v18)
DM 10.1 Rationale
Patients with diabetes are at high risk of foot complications.
Inspection for vasculopathy and neuropathy is needed to detect problems. These
checks should be carried out at an annual review.
It is very important that correct testing for sensory neuropathy
is carried out using the appropriate equipment. The foot inspection and assessment
should include identifying the presence of sensory neuropathy (loss of the ability
to feel a monofilament, vibration or sharp touch) and/or the abnormal build
up of callus.
Both vibration perception threshold measurement using a biothesiometer
and sensation threshold measurement using a 10g monofilament accurately predict
neuropathic patients at raised risk of ulceration. The 10g monofilament is convenient
and easy to use. Longevity and recovery testing suggests that each monofilament
will survive usage on approximately ten patients before needing a recovery time
of 24 hours (to restore buckling strength) before further use. Identification
of neuropathy based on insensitivity to a 10g monofilament is convenient and
appears cost-effective.
Further information NICE clinical guideline 10 (2004). Type 2
diabetes: prevention and management of foot problems. http://guidance.nice.org.uk/CG10
DM 10.2 Reporting and verification
The practice reports the percentage of patients on the diabetic
register with a record of neuropathy testing in the preceding 15 months.
Prepared By Jean Keenan