This module maps to the four Medicare skilled-nursing categories. Document the one(s) that apply this visit in coverage language.
Observation and assessment
Performing standardized sensory testing, recognizing the loss of protective sensation, distinguishing a stable chronic deficit from a sudden or central one, and identifying unnoticed injury in insensate areas require the knowledge and judgment of a licensed nurse. Serial sensory testing against baseline is the core of observation and assessment for this domain.
Teaching and training
Teaching daily foot and skin inspection, protective footwear, burn and injury prevention, and fall precautions for an insensate or proprioceptively impaired patient — to patient and caregiver competence with return demonstration — is skilled teaching and training and is the dominant skilled service for chronic neuropathy.
Management and evaluation of the plan of care
Evaluating whether the protection plan is preventing injury and coordinating revisions — footwear, offloading, glycemic control, neuropathic-pain management, or referral — when sensation declines or an injury occurs is skilled management and evaluation of the plan of care.
Skilled procedures
Skilled procedures in this domain are limited; the monofilament and sensory testing themselves are the skilled assessment, and wound care for any resulting lesion is documented in Wounds.
