Name of the Procedure:

Foot Examination (HCPCS Code G9226)

Common Names:

• Diabetic foot examination
• Monofilament test
• Comprehensive foot exam

Summary

A foot examination includes a visual inspection of the foot, a sensory test using a 10-g monofilament, and additional tests such as vibration perception with a tuning fork, pinprick sensation check, or ankle reflexes assessment. This procedure helps identify any abnormalities or potential complications, especially in patients with diabetes.

Purpose

This procedure primarily aims to detect early signs of foot problems, particularly in individuals with diabetes, who are at a higher risk for foot neuropathy and ulcers. Early detection can prevent severe complications, including infections and amputations.

Indications

• Patients with diabetes
• Symptoms of neuropathy such as numbness or tingling in the feet
• Reduced sensation in the feet
• History of foot ulcers or amputations

Preparation

• Patients should remove any footwear and socks.
• No specific fasting or medication adjustments are generally required.
• Recent medical history should be reviewed.

Procedure Description

1. Visual Inspection: The healthcare provider examines the foot for any skin changes, ulcers, or deformities.
2. Sensory Examination: A 10-g monofilament is used to test sensory response by touching various points on the foot.
3. Additional Testing:
   • Vibration Test: A 128-Hz tuning fork may be used to evaluate vibration perception.
   • Pinprick Sensation: A small pin is used to check pain response.
   • Ankle Reflexes: Using a reflex hammer, ankle reflexes are tested to assess nerve function.

Tools and Equipment:

• 10-g monofilament
• 128-Hz tuning fork
• Reflex hammer
• Pin for pinprick sensation

No anesthesia or sedation is typically required.

Duration

The procedure usually takes around 10-15 minutes.

Setting

It is performed in a clinical setting, such as a doctor's office or outpatient clinic.

Personnel

• Primary care physician or podiatrist
• Nurse or medical assistant

Risks and Complications

• Minimal risks involved.
• In rare cases, discomfort may occur during the pinprick test.

Benefits

• Early detection of foot-related issues.
• Prevention of serious complications such as ulcers or amputations.
• Improvement in overall foot health and management.

Recovery

• No significant recovery time is needed.
• Patients can resume normal activities immediately.
• Follow-up appointments may be scheduled if any abnormalities are found.

Alternatives

• Routine visual inspections at home.
• Regular visits to a podiatrist for specialized assessments.
• Usage of other sensory testing devices or methods.

Patient Experience

During the procedure, patients might feel slight pressure or tingling, especially during sensory tests. Pain management measures are typically not necessary, as the procedure is generally painless.

Overall, this examination is well-tolerated and provides crucial information for managing foot health, especially in patients with diabetes.