Name of the Procedure:

Initial Physician Evaluation and Management of a Diabetic Patient with Diabetic Sensory Neuropathy Resulting in a Loss of Protective Sensation (LOPS)
Common Names: Diabetic Neuropathy Evaluation
Technical Terms: HCPCS Code G0245

Summary

This procedure involves the initial evaluation and management of a diabetic patient who suffers from neuropathy—specifically loss of protective sensation (LOPS). LOPS is a severe form of nerve damage that can put a patient at risk for foot ulcers and other complications.

Purpose

Medical Conditions:

• Diabetic Sensory Neuropathy
• Loss of Protective Sensation (LOPS)
  Goals:
• Identify and diagnose LOPS
• Assess the risk of complications
• Develop a management plan to prevent ulcers and other issues

Indications

Symptoms:

• Numbness in the feet
• Lack of sensation in the feet
• History of foot ulcers Criteria:
• Diagnosed diabetes mellitus
• Evidence of neuropathic symptoms affecting sensory perception in the feet

Preparation

Pre-procedure Instructions:

• No specific instructions; general advice to wear comfortable clothing
• Bring a list of current medications Diagnostic Tests:
• Comprehensive foot examination
• Monofilament test for sensation
• Possible blood tests for glycemic control

Procedure Description

1. Patient History:
   • Collect detailed medical and diabetic history
   • Document symptoms and any history of foot ulcers or infections
2. Physical Examination:
   • Inspect the feet for any signs of abnormalities or existing ulcers
   • Perform monofilament testing on various points of the foot to assess protective sensation
   • Evaluate blood flow and skin condition
3. Development of Management Plan:
   • Discuss appropriate footwear and preventive strategies
   • Consider referral to a podiatrist if necessary

Tools and Equipment:

• Monofilament testing device
• Blood pressure cuff for ankle-brachial index (ABI) if indicated
• Examination light and magnifying glass

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic or primary care physician's office.

Personnel

• Primary Care Physician (PCP)
• Nurse or Medical Assistant

Risks and Complications

Common Risks:

• Minimal risks; primarily involves physical examination Rare Complications:
• Discomfort during monofilament testing
• Potential for overlooking early symptoms if not comprehensively assessed

Benefits

Expected Benefits:

• Early detection of LOPS reduces the risk of foot ulcers
• Tailored management plan can prevent complications Timeline:
• Immediate benefits with proper recommendations for footwear and foot care

Recovery

Post-procedure Care:

• Regular follow-up appointments
• Implement recommended foot care regimen
• Monitor blood glucose levels Recovery Time: There is no recovery time as it is a non-invasive evaluation.

Alternatives

Other Treatment Options:

• Regular self-monitoring of feet for changes
• Podiatry consultations
• Neurologist evaluation for more severe cases
  Pros and Cons:
• Regular PCP visits allow for continuous monitoring but may lack specialized care
• Podiatry offers specialized expertise but may require referral and additional visits

Patient Experience

During the Procedure:

• Some patients might feel slight discomfort during sensory testing After the Procedure:
• Typically no pain; patients might feel relief from understanding their condition better Pain Management:
• Generally, no pain management is needed, but patients will receive advice on preventing discomfort from neuropathy.