Measure 126: Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy: Neurological Evaluation (SOAP 2.0)

This is a guide for 2.0 measure reporting. For 1.0 measure reporting, click here.

Measure 126 is about preventing amputations for patients diagnosed with diabetes. Foot ulceration is the most common single reason for individuals with diabetes to need a lower extremity amputation. A timely neurological evaluation can detect the development of peripheral neuropathy early so that skin damage can be avoided. 

Who can report this measure?

PTs can report this measure.

Patient Qualifications

  • Patient age (18 or older)
  • Visit type: Initial Evaluation or Re-Evaluation
  • Performance of neurological exam of lower extremities within the last 12 months
  • A diagnosis code for diabetes is needed. This may seem like an obvious statement, but most measures that therapists are eligible to report on do not have a diagnosis code requirement. This measure description lists all of the eligible ICD-10 codes that trigger reporting. 

When do I report on this measure?

At least once per the performance period (calendar year) for patients with a qualifying diagnosis (e.g., Diabetes Mellitus) and only when an eligible procedure code is billed. Evaluation frequency is decided by the Risk Profile determined during the examination, which is included in the Measure Specification Guide.

Eligible Procedure Codes
PT: 97161, 97162, 97163, 97164 

Measure Requirements

A mix of clinical actions is needed to meet the measure’s intent. Tests or measures must capture sensory AND motor function in the legs:

  • A 10-g monofilament test of specified areas of the feet is required.
  • You must also perform one or more of the following: vibration test using 128-Hz tuning fork, pinprick sensation test, ankle reflexes, or a vibration perception threshold test.
  • You also should perform any other examination techniques as indicated by the specific patient’s presentation

Measure Specification

For more information on Measure 126, please see the Measure Specification Guide.

Measure Reporting in the WebPT EMR

  1. Click the MIPS badge in the Case Summary to view the current Measure Status. Here you will see all measures that the patient is eligible for based on their Diagnoses and Procedure Code.
  2. On the Assessment section, validate or add the diagnosis code for diabetes. A diagnosis code for diabetes is needed to trigger measure reporting.
  3. On the Objective section, you have the option of selecting which tests you’d like to use to satisfy the measure requirements.
  4. Required: Semmes Weinstein Lower is a required test for Measure 126. Select the Sensation subsection.
  5. Administer the Semmes Weinstein Lower and record the results using the radio buttons. If the findings were normal with exceptions, select the appropriate results using the drop-down menus.
  6. Additional Tests: In addition to Semmes-Weinstein, you must complete one or more of the following tests to satisfy the requirements: Dermatomes Lower, Reflexes Lower, 2 Point Discrimination, Sharp + Dull. Once at least two tests have been completed, the measure will be met.A. Dermatomes Lower
    B. Reflexes Lower
    C. Sharp + Dull; 2 Point
  7. Dermatomes Lower: On the Objective section, select the Neurologic Screen subsection. Administer the test and record the results using the radio buttons. If the findings were normal with exceptions, select the appropriate results using the drop-down menus.
  8. Reflexes Lower: On the Objective section, select the Deep Tendon Reflex Exam subsection. Administer the test and record the results using the radio buttons. If the findings were normal with exceptions, select the appropriate results using the drop-down menus.
  9. Sharp & Dull: On the Objective section, select the Sensation subsection. Select Location+ and record the results. Additional recordings may be made by selecting Location+.
  10. 2 Point: On the Objective section, select the Sensation subsection. Administer the test and record the results using the radio buttons. If the findings were normal with exceptions, select the appropriate results using the drop-down menus.
  11. Measure Met: Complete the Semmes Weinstein Lower and at least one additional test to satisfy measure requirements. Completing two lower extremity neurological exams triggers a Measure Met indicator in the Measure Status column.
  12. Excluded: Select the Excluded radio button if the patient:
    • Patient is not an eligible candidate
    • Patient is in an emergent medical situation
  13. Not Met: Select the Not Met radio button if a lower extremity neurological exam is not performed. 
  14. If the note is signed without completing the required fields, an alert will appear. Required fields must be completed before submitting the note.

Diagnoses that Trigger Reporting (ICD-10)

E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.3211, E10.3212, E10.3213, E10.3219, E10.3291, E10.3292, E10.3293, E10.3299, E10.3311, E10.3312, E10.3313, E10.3319, E10.3391, E10.3392, E10.3393, E10.3399, E10.3411, E10.3412, E10.3413, E10.3419, E10.3491, E10.3492, E10.3493, E10.3499, E10.3511, E10.3512, E10.3513,  E10.3519, E10.3521, E10.3522, E10.3523, E10.3529, E10.3531, E10.3532, E10.3533, E10.3539, E10.3541, E10.3542, E10.3543, E10.3549, E10.3551, E10.3552, E10.3553, E10.3559, E10.3591, E10.3592, E10.3593, E10.3599, E10.37X1, E10.37X2, E10.37X3, E10.37X9, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.10, E11.11, E11.21, E11.22, E11.29, E11.311, E11.319, E11.3211, E11.3212, E11.3213, E11.3219, E11.3291, E11.3292, E11.3293, E11.3299, E11.3311, E11.3312, E11.3313, E11.3319, E11.3391, E11.3392, E11.3393, E11.3399, E11.3411, E11.3412, E11.3413, E11.3419, E11.3491, E11.3492, E11.3493, E11.3499, E11.3511, E11.3512, E11.3513, E11.3519, E11.3521, E11.3522, E11.3523, E11.3529, E11.3531, E11.3532, E11.3533, E11.3539, E11.3541, E11.3542, E11.3543, E11.3549, E11.3551, E11.3552, E11.3553, E11.3559, E11.3591, E11.3592, E11.3593, E11.3599, E11.37X1, E11.37X2, E11.37X3, E11.37X9, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11, E13.21, E13.22, E13.29, E13.311, E13.319, E13.3211, E13.3212, E13.3213, E13.3219, E13.3291, E13.3292, E13.3293, E13.3299, E13.3311, E13.3312, E13.3313, E13.3319, E13.3391, E13.3392, E13.3393, E13.3399, E13.3411, E13.3412, E13.3413, E13.3419, E13.3491, E13.3492, E13.3493, E13.3499, E13.3511, E13.3512, E13.3513, E13.3519, E13.3521, E13.3522, E13.3523, E13.3529, E13.3531, E13.3532, E13.3533, E13.3539, E13.3541, E13.3542, E13.3543, E13.3549, E13.3551, E13.3552, E13.3553, E13.3559, E13.3591, E13.3592, E13.3593, E13.3599, E13.37X1, E13.37X2, E13.37X3, E13.37X9, E13.36, E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9