Neurosurgery Coding Alert

Confirm laterality and dominant side for hemiplegia, monoplegia; determine level for quadriplegia.

Here are answers to the quiz on page 35. Careful assessment of the explanation will help you to determine the most precise code for these common paralytic diagnoses.

Answer 1: The correct answer is option a, G80.4 (Ataxic cerebral palsy).

Code G80.4 is for ataxic cerebral palsy. Codes G80.1 (Spastic diplegic cerebral palsy) and G80.2 (Spastic hemiplegic cerebral palsy) are for spastic diplegic and hemiplegic cerebral palsy, respectively. Code G80.3 (Athetoid cerebral palsy) is for athetoid cerebral palsy.

What is ataxic cerebral palsy? Ataxic cerebral palsy is a condition in which the patient loses balance and coordination. It manifests as instability and disorganized movements.

Answer 2: The correct answer is option b, G83.11 (Monoplegia of lower limb affecting right dominant side).

Code G83.11 is for lower limb monoplegia on the right dominant side, while code G83.12 (Monoplegia of lower limb affecting left dominant side) is for lower limb monoplegia on the left dominant side. When your physician does not specify the side of monoplegia, you submit code G83.10 (Monoplegia of lower limb affectingunspecified side). For lower limb monoplegia affecting the right nondominant side, you submit code G83.13 (Monoplegia of lower limb affecting right nondominant side).

Answer 3: The correct answer is option c, G81.04 (Flaccid hemiplegia affecting left nondominant side).

The codes G81.03 (Flaccid hemiplegia affecting right nondominant side) and G81.04 are both for flaccid hemiplegia of the nondominant side. Since the patient is right-handed and has hemiplegia on the left (nondominant) side, you submit code G81.04.

The codes G81.13 (Spastic hemiplegia affecting right nondominant side) and G81.14 (Spastic hemiplegia affecting left nondominant side) are for spastic hemiplegia on the right and left nondominant sides, respectively.

Spastic vs. flaccid hemiplegia: Spastic and flaccid hemiplegia differ in the tone of the paralyzed muscles. In spastic hemiplegia, the muscle tone is increased and the muscles become stiff. In contrast, in flaccid hemiplegia, there is loss of muscle tone and the body becomes limp. Spastic hemiplegia reflects a primarily upper motor neuron dysfunction that develops sometime after the original brain injury, whereas a flaccid hemiplegia typically occurs in the acute phase of the original brain injury.

Answer 4: The correct answer is option a, G82.50 (Quadriplegia, unspecified).

The codes G82.50, G82.51 (Quadriplegia, C1-C4 complete), G82.52 (Quadriplegia, C1-C4 incomplete), and G82.53 (Quadriplegia, C5-C7 complete) are all for quadriplegia. The question does not specify any details of quadriplegia, so you select G82.50 for the quadriplegia.

Codes G82.51 and G82.52 are for complete and incomplete quadriplegia, respectively. You submit these codes for injury at C1-C4 in the spinal cord. The code G82.53 is for complete quadriplegia due to injury at level C5-C7 in the spinal cord.

Complete vs. incomplete spinal injuries: In complete spinal injury, the patient has no sensation or movement below the level of the injury. In incomplete spinal injuries, the patient may have varying degrees of sensation and/or motor function below the level of the injury.

Answer 5: The correct answer is option c, G80.8 (Other cerebral palsy).

The code G80.8 is for cerebral palsy other than the spastic diplegic, hemiplegic, quadriplegic cerebral palsy, congenital spastic cerebral palsy, athetoid cerebral palsy, and ataxic cerebral palsy. The code applies to mixed cerebral palsy, which may have features of spastic, athetoid, and ataxic cerebral palsies.

The codes G80.4 (Ataxic cerebral palsy), G80.3 (Athetoid cerebral palsy), and G80.2 (Spastic hemiplegic cerebral palsy) are for ataxic, athetoid, and spastic hemiplegic cerebral palsy, respectively.