Neurosurgery Coding Alert

Levels guide your diagnosis coding in ICD-9 and ICD-10.

You’ll stand a better chance of selecting the correct quadriplegia code in ICD-10 if you focus on the spinal level and the extent of the condition. Here is a quick review on the codes to bring you up to speed. 

Look For One-To-One Mapping in ICD-10

When reporting quadriplegia in ICD-10, 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. “A complete quadriplegia is defined as no motor or sensory function below the last functioning dermatomal or myotomal level,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

For complete quadriplegia caused by lesion between C1 to C4, you report ICD-9 code 344.01 (Quadriplegia C₁-C₄ complete) and for incomplete quadriplegia with lesion at the same level, you report 344.02 (Quadriplegia C₁-C₄ incomplete). The corresponding ICD-10 codes are G82.51 (Quadriplegia, C₁-C₄ complete) and G82.52 (Quadriplegia, C₁-C₄ incomplete), respectively.

You have similar code choices for the C5 to C7 levels. For complete quadriplegia, report 344.03 (Quadriplegia, C₅-C₇ complete). The corresponding ICD-10 is G82.53 (Quadriplegia, C₅-C₇ complete). For incomplete quadriplegia at this level, you report ICD-9 code 344.04 (Quadriplegia C₅-C₇ incomplete) and ICD-10 code G82.54 (Quadriplegia, C₅-C₇ incomplete).

Exclude ‘Other’ in ICD-10

When your neurosurgeon does not document the level of lesion in quadriplegia or does not capture the extent of quadriplegia, submit 344.00 (Quadriplegia unspecified) when following ICD-9. You also have a category in ICD-9 designated for ‘other quadriplegia’: 344.09. Both these codes map to diagnosis G82.50 (Quadriplegia, unspecified) in ICD-10. Notice that ICD-10 doesn’t offer a choice for ‘Other’ quadriplegia so includes this category with ‘Unspecified’ quadriplegia. You report these codes for old and longstanding conditions of unspecified cause.