Age must be 17 or over with a diagnostic code for diabetes mellitus that has
not been resolved.
Foot risk Clasification codes (Only one code required, recorded in the previous
- 2G5E. O/E - Right diabetic foot at low risk
2G5F. O/E - Right diabetic foot at moderate risk
2G5G. O/E - Right diabetic foot at high risk
2G5H. O/E - Right diabetic foot - ulcerated
2G5I. O/E - Left diabetic foot at low risk
2G5J. O/E - Left diabetic foot at moderate risk
2G5K. O/E - Left diabetic foot at high risk
2G5L. O/E - Left diabetic foot - ulcerated
2G5d. O/E - Left diabetic foot at increased risk
2G5e. O/E - Right diabetic foot at increased risk
Excluded if both Feet have been Amputated.
- 2G42. O/E - Amputated right leg
2G44. O/E - Amputated right above knee
2G46. O/E - Amputated right below knee
2G43. O/E - Amputated left leg
2G45. O/E - Amputated left above knee
2G47. O/E - Amputated left below knee
Foot examination exception codes (Added in the last 12 months)
8I6G. Diabetic foot examination not indicated
8I3W. Diabetic foot examination declined
8IAo. Foot pulse check declined
8IB6. Patient unsuitable for foot pulse check
8IAn. Neuropathy assessment declined
8IB5. Patient unsuitable for neuropathy assessment
Diabetes exception reporting codes
(Added in the last 12 months)
- 9h4.. Exception reporting: diabetes quality indicators
- 9h41. Excepted from diabetes quality indicators: Patient
- 9h42. Excepted from diabetes quality indicators: Informed
The percentage of patients with diabetes with a record of a foot
examination and risk classification: 1) low risk (normal sensation, palpable
pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy
or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated
foot within the preceding 12 months
DM 012.1 Rationale
Patients with diabetes are at high risk of foot complications.
Evaluation of skin, soft tissue, musculoskeletal, vascular and neurological
condition on an annual basis is important for the detection of feet at raised
risk of ulceration.
The foot inspection and assessment should include:
- identifying the presence of sensory neuropathy (loss of the ability to feel
a monofilament, vibration or sharp touch) and/or the abnormal build up of
- identifying when the arterial supply to the foot is reduced (absent foot
pulses, signs of tissue ischaemia or symptoms of intermittent claudication)
- identifying deformities or problems of the foot (including bony deformities,
dry skin or fungal infection), which may put it at risk
- identifying other factors that may put the foot at risk (which may include
reduced capacity for self-care, impaired renal function, poor glycaemic control,
cardiovascular and cerebrovascular disease, or previous amputation).
NICE clinical guideline
10 (2004). Type 2 diabetes: prevention and management of foot problems.
The NICE guideline on Type 2 diabetes: the prevention and management of foot
problems advises that foot risk is classified as:
- at low current risk: normal sensation, palpable pulses
- at increased risk: neuropathy or absent pulses or other risk factor
- at high risk: neuropathy or absent pulses plus deformity or skin changes
or previous ulcer
- ulcerated foot.
The practitioner carrying out the inspection and assessment is advised to:
- discuss with the patient their individual level of risk and agree plans
for future surveillance
- initiate appropriate referrals for expert review of those with increased
- give advice on action to be taken in the event of a new ulcer/lesion arising
- give advice on the use of footwear which will reduce the risk of a new ulcer/lesion
- give advice on other aspects of foot care which will reduce the risk of
a new ulcer/lesion.
For the purpose of QOF the Read codes for 'moderate risk' are
used to record the concept of 'increased risk'.
In NHS Scotland, foot risk is calculated by using the SCI-DC electronic
foot risk screening tool which is based on the SIGN clinical guideline 116 foot
risk algorithm and as such is recognised as best practice and encouraged for
use in Scotland.
DM 012.2 Reporting and verification
See indicator wording for requirement criteria.
Prepared By Jean Keenan