Name of the Procedure:

Follow-up Physician Evaluation and Management of a Diabetic Patient with Diabetic Sensory Neuropathy Resulting in a Loss of Protective Sensation (LOPS)
Common Names: Diabetes follow-up visit, Neuropathy check-up
Medical Terms: HCPCS G0246, Diabetic neuropathy evaluation

Summary

This is a medical follow-up visit where a physician evaluates and manages a diabetic patient who has developed sensory neuropathy. Sensory neuropathy is a condition where nerve damage leads to loss of sensation, particularly in the feet, which can result in difficulty feeling pain—this is known as Loss of Protective Sensation (LOPS).

Purpose

The primary goal of this procedure is to:

• Monitor the progression of diabetic sensory neuropathy
• Manage symptoms
• Prevent complications such as foot ulcers and infections
• Provide education on preventing injury and maintaining foot health

Indications

• Diagnosis of diabetes
• Evidence of sensory neuropathy, particularly symptoms of numbness or tingling in the extremities
• Confirmed Loss of Protective Sensation (LOPS) in the feet or other extremities

Preparation

• Patients should bring a list of current medications
• Wear comfortable clothing that allows ease of access to feet and legs
• No fasting required unless specified by the physician
• Preliminary tests might include blood sugar levels and a comprehensive foot exam

Procedure Description

1. Patient History: The physician will review the patient's medical history, medication usage, and any symptoms of neuropathy.
2. Physical Examination:
   • Inspection of the feet for cuts, sores, infections, and other abnormalities
   • Neurovascular assessments (monofilament testing for sensation)
   • Evaluation of footwear and gait
3. Management Plan:
   • Discuss control of blood glucose levels
   • Recommend lifestyle changes, including diet and exercise
   • Prescription of medication for pain management or nerve health, if necessary
   • Referral to a podiatrist or specialist for further treatment or orthotic recommendations

Tools and Equipment: Monofilament device, tuning fork, Doppler device (if necessary)

No anesthesia or sedation is required for this procedure.

Duration

Typically, the visit lasts about 30-45 minutes.

Setting

This procedure is usually performed in:

• Outpatient clinic
• Physician’s office

Personnel

• Primary care physician or endocrinologist
• Nurse or medical assistant for preliminary assessments

Risks and Complications

While the procedure itself carries minimal risk, the primary concerns include:

• Missed diagnosis of foot complications, which can lead to severe outcomes if not treated early
• Inaccurate blood glucose management leading to worsening of symptoms

Benefits

• Early detection and management of foot complications
• Improved quality of life through better symptom control
• Prevention of severe complications like foot ulcers and infections
• Education on self-care and injury prevention

Recovery

• No specific recovery time since it is a non-invasive evaluation
• Immediate ability to resume normal activities with special attention to foot care
• Follow-up appointments as recommended based on findings

Alternatives

• Regular diabetes check-ups without a specific focus on neuropathy
• Home-based monitoring with periodic professional evaluations
• Remote consultations via telemedicine for those unable to visit in person

Pros and Cons:
In-clinic evaluation ensures thorough examination and immediate intervention.
Home monitoring might not detect all issues timely.

Patient Experience

During the procedure, patients might feel slight discomfort during sensation tests (e.g., monofilament testing). Post-procedure, they should feel reassured having a clear understanding of their condition and management plan. Proper pain management and comfort measures, such as cushioned seating and gentle examination techniques, will be employed throughout the visit.

By following the physician’s recommendations, patients can expect improved symptom management and a detailed plan for maintaining their foot health.