Neurosurgery Coding Alert

Hint: Make sure you know whether the quadriplegia is complete or incomplete.

Finding the correct ICD-10 codes can be tricky with any diagnosis you must report. This is especially true with quadriplegia because this condition can be complete or incomplete and it can affect different parts of the spinal cord.

Check out the following FAQs to keep your quadriplegia claims in tip-top shape.

FAQ 1: What is quadriplegia?

Answer 1: Quadriplegia implies the inability to move both the arms and the legs. Some physicians use the alternate term “tetraplegia” instead of quadriplegia. If you break the word down into parts, you see that “quad” means “four,” and “plegia” means “inability to move.” Some providers also use the alternate term “tetraplegia” instead of quadriplegia.

The major cause for quadriplegia is injury to the spinal cord. This injury is referred to as lesion in the spinal cord. The level of the lesion in the spinal cord determines the loss of function.

The loss of movement depends upon the level in the spinal cord where the injury occurred and how grievous the damage was. Quadriplegia can be partial or complete.

FAQ 2: What is the difference between complete quadriplegia versus incomplete quadriplegia?

Answer 2: In complete spinal injuries, 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

FAQ 3: What ICD-10 code should we report for unspecified quadriplegia?

Answer 3: For unspecified quadriplegia, you would report G82.50 (Quadriplegia, unspecified).

FAQ 4: When should you report codes G82.51 through G82.54?

Answer 4: When reporting quadriplegia in ICD-10, you should first begin by checking in the clinical note for the level where the lesion lies in the cervical spine (that is, whether the lesion between C1 to C4 or between C5 to C7). Next, confirm whether the quadriplegia was complete or incomplete.

For complete quadriplegia caused by a lesion between C1 to C4, you should report G82.51 (Quadriplegia, C1-C4 complete). For incomplete quadriplegia with a lesion at the same level, you should report G82.52 (Quadriplegia, C1-C4 incomplete).

For complete quadriplegia caused by a lesion between C5-C7, you should report G82.53 (Quadriplegia, C5-C7 complete). For incomplete quadriplegia at this level, you would report G82.54 (Quadriplegia, C5-C7 incomplete).

FAQ 5: In the ICD-10 tabular index, there are notes under category G82- (Paraplegia (paraparesis) and quadriplegia (quadriparesis). Could you please explain what these notes mean?

Answer 5: “This category is to be used only when the listed conditions are reported without further specification, or are stated to be old or longstanding but of unspecified cause,” according to ICD-10. “The category is also for use in multiple coding to identify these conditions resulting from any cause.”

The instructional language shows that these are non-specific diagnostic codes which are intended to be applied only when there is no more specific documentation to allow choosing a more specific ICD-10 code, when the condition is chronic and of unknow etiology, and among other codes when the cause of the quadriplegia is not known, explains Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

FAQ 6: The indication states that the patient is unable to move his upper limbs, but the patient has no history of neurological disorder. Additionally, the brain scan did not reveal any significant findings. Should I code this as functional quadriplegia?

Answer 6: Before the 2018 ICD-10-CM manual was published, the answer to this question would have been no. ICD-10-CM used to instruct you to only code as R53.2 (Functional quadriplegia) if the report specifically stated “functional quadriplegia.”

However, as you can see in the 2018 guidelines, the ICD-10-CM manual removed the guidelines specific to functional quadriplegia coding, effective on Oct. 1, 2017. Therefore, you should rely exclusively on the index to direct you to the correct code. In the case of the indicating diagnosis, you can search under Immobile, immobility ⇒ complete, due to severe physical disability or frailty, which leads you to R53.2.

Functional quadriplegia defined: Functional quadriplegia is a term that may be attributed to psychological conditions that manifest as quadriplegia, Przybylski says. While the brain and spinal cord are functional and have the capacity to move the limbs, a psychiatric illness precludes the patient from displaying movement. Such patients will also not perceive sensation. This is different from malingering, in which the quadriplegia is being displayed intentionally.