The semmesweinstein monofilament swm test is considered the gold standard to screen for loss of protective sensation. The semmes weinstein monofilament examination as a. Medicare feeforservice providers the hyperlink table, at the end of this document, provides the complete url. According to the american diabetes association, all patients with diabetes should be screened for loss of protective sensation in their feet peripheral neuropathy when they are diagnosed and at least annually thereafter, using simple clinical tests such as the semmesweinstein monofilament exam. Users outside the medical profession are welcome to use this website, but no content on the site should be interpreted as medical advice. Therapeutic shoes for persons with diabetes documentation checklist required documentation all claims documentation of a dispensing order preliminary written or verbal order that contains. Description of the item prescribing physicianpractitioners name name of the beneficiary date of order. Monofilament testing proceduresouth west regional wound care programlast updated march 4, 2015 1 note. The painful conditions of the ankle and foot are very common presentations and most commonly caused by trauma or injury related to sport activities. This document is not a substutute for proper training. Frequently used cpt ii codes for medicare advantage. The semmes weinstein monofilament examination as a screening.
Documentation of medical reason for not performing foot exam i. The technique for testing pressure perception with the 10g monofilament is illustrated in fig. Lipids elevated w total cholesterol 230, hdl 36, ldl 162, triglycerides 160 tsh normal at 2. How to do a 3minute diabetic foot exam mdedge family medicine. A printed copy may not reflect the current electronic version on the swrwcps website. A sensory exam using the 10 gram monofilament is performed at the indicated on the foot. On the physical exam section of the soap tab, notice you now have direct access to a link specifically for the diabetic foot exam. Define preventative strategies to reduce the risk of diabetic foot. The soapnote project website is a testing ground for clinical forms, templates, and calculators. Diabetic foot exam fill out and sign printable pdf template.
Comprehensive foot examination and risk assessment. What are the normal results for a monofilament exam. It is a late finding in type 1 diabetes but can be an early finding in type 2 diabetes. Pdf comprehensive foot examination and risk assessment. Ankle and foot exam stanford medicine 25 stanford medicine. The task force agrees that any of the five tests listed could be used by clinicians to identify lops, although ideally two of these should be regularly performed during the screening examnormally the 10g monofilament and one other test.
Touches the monofilament to the patients arm asks the patient to close their eyes or look away test each of the ten areas of the foot designated with a 5. Understand the pathogenesis of diabetic foot ulcerations dfus. A diabetic foot exam is considered to be a component of em, so when such an exam occurs on the same date of service as an office visit, you cannot bill codes for both. Nov 21, 20 1 min 26 sec video demonstrating the monofilament, screening, podiatric exam for those with diabetes. Author and disclosure information this brief exam will help you to quickly detect major risks and prompt you to refer patients to appropriate specialists. Guarantee only applies to situations where liability is based solely on inadequate documentation. Oct 11, 2016 explains the monofilament portion of a foot exam. Use a 3 step sequence that includes 1 touch the skin, 2 bend the.
This document will describe the technique to be used to perform monofilament testing on all diabetic patients. The clinical exam recommended, however, is designed to identify loss of protective sensation lops rather than early neuropathy. This document is not a substutute for proper training, experience, and excercising of professional judgment. Assessment significant findings using a monofilament patient history previous foot ulceration apply the filament to a sensitive area of skin e. If a patient had a true transmetatarsal amputation on the right and a normal exam for all points tested on the right and left, what are the results and how would you document. Monofilament exam will be performed annually for persons with diabetes and quarterly for high risk or patients with diminished sensation.
Learn how to perform this screening and download a. Jun 01, 2005 diabetic neuropathy is a debilitating disorder that occurs in nearly 50 percent of patients with diabetes. Screening of the diabetic foot how to use of a 10g monofilament. Accuracy of monofilament testing to diagnose peripheral. Monofilament testing was done using the nhanes protocol with a. This document will describe the technique to be used to. Weinstein monofilament examination swme in diagnosing diabetic. Diabetic neuropathy is a debilitating disorder that occurs in nearly 50 percent of patients with diabetes. Diabetic foot screen for loss of protective sensation. The 10g monofilament is an objective and simple instrument used in screening the diabetic foot for loss of. A sensory exam using the 10 gram monofilament is performed at the indicated on the foot drawing.
Many studies have been published proposing a range of tests that might usefully identify patients at risk of foot ulceration, creating confusion among practitioners as to which. Incomplete documentation of foot assessments can pose a significant risk to residents, especially because a history of foot problems is an important factor for. Submit an advance beneficiary notice of noncoverage to cms when you anticipate that the program will not cover a service. Comprehensive foot examination and risk assessment diabetes. How to do a 3minute diabetic foot exam mdedge family. Sensory testing of patients with diabetes is an integral part of preventing new and recurrent wounds. It is important to be familiar with some basic physical exam maneuvers necessary to confirm the presence of a lesion and to assess its severity. Five registered nurses in an outpatient diabetes clinic were educated on how to perform a monofilament exam using recommendations by the ada.
In the last group of charts, there were three patients diagnosed with neuropathy in addition to the diabetes in 0520, and 0820, 0920, respectively. Learn how to perform this screening and download a free neuropathic foot exam guide. Foot exam was not performed, reason not otherwise specified. Improving the compliance of the annual foot examination and. The lifetime incidence of foot ulcers in diabetic patients is 19 34%. Diabetic foot ulcerations are one of the most common complications associated w diabetes with a global annual incidence of 6. Educating registered nurses to perform monofilament exams by. With the correct use of cptii codes, youve already given us the preventive care information we need. Monofilament testing procedure south west regional wound. Your provider will place a tuning fork or other device against your foot and toes to see if you can feel the vibration it produces. The basics of diabetic foot care indian health service. A printed copy may not reflect the current, electronic version on the clck intranet. A manual muscle test of foot and great toe dorsi and plantar flexion.
The exam, which well describe here, consists of 3 components. Diabetic foot screen for loss of protective sensation hrsa. The clinical examination to identify lops is simple and requires no expensive equipment. Description of the item prescribing physicianpractitioners name. Other issues such as medical necessity, improper code selection and over utilization do not apply.
Enter your official identification and contact details. The way to complete the online diabetic foot exam on the internet. Elements of the neuro exam cranial nerves motor bulk, tone, strength coordination fine movements, balance sensation pain, touch, position sense, vibration reflexes gait mental status covered elsewhere. Performs the monofilament exam per gimc policy and procedure. Screening of the diabetic foot how to use of a 10g. How to do a semmes weinstein monofilament exam wound. The 10g monofilament is an objective and simple instrument used in screening the diabetic foot for loss of protective sensation. Only 8% of patient charts included documentation of foot assessments prior to the training, compared with 38% after the training p. Foot sensation testing in the patient with diabetes. Diabetic foot exam normal with intact monofilament sensation bilaterally. For performance of the 10g monofilament test, the device is placed perpendicular to the. The advanced tools of the editor will lead you through the editable pdf template.
Pdf boulton, andrew j m find, read and cite all the research you need on researchgate. Your provider will brush a soft nylon fiber called a monofilament over your foot and toes to test your foots sensitivity to touch. This testing is to be performed annually on all diabetic patients, even those who see a podiatrist regularly for foot care. Monofilament test negative monofilament test is performed on the effected limb in the patient with diabetes mellitus. Medicare coverage of physical examsknow the differences. The semmesweinstein monofilament is a welldocumented alternative to vpt for predicting ulcer risk 2628 and has long been advocated as an essential component of a thorough foot exam. One way to assess protective sensation in the diabetic foot is to perform a semmes weinstein 10g monofilament test. Evaluation and prevention of diabetic neuropathy american. Examine standards of care in regards to diabetic foot care. The monofilament is used to touch the base of the effected limb, if the patient feel pain on touching the monofilament, judged by patients verbal communication, the result of this test is negative and the patient condition can be recovered with medications and some strict. Improving the compliance of the annual foot examination. Annual wellness visit awv visit to develop or update a. Improving the compliance of the annual foot examination in.
Diabetic foot examination competency exam monofilament examination competency quiz 1. Diabetic foot screen for loss of protective sensation national hansens disease programs, leap program, 1770 physicians park dr. Plantar surface of the hallux and 3rd toe 1st, 3rd and 5th metatarsal heads. One of the most common complications of diabetes is neuropathy, or nerve damage of the extremities. It is important that a properly calibrated device is used to ensure that 10g of linear pressure are being applied so a true measurement is being assessed. Guarantee limited to documentation custom generated by safestep and required by medicare. How to obtain reimbursement for diabetic foot exams.
1339 870 459 1124 561 392 669 1149 879 394 278 532 43 698 754 1112 1028 760 113 602 1479 1392 739 271 1421 1206 600 982 1464 1346 1230 1216 139 212 951 1368 907 1225 1107