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It is unlikely that a clinician would overlook properly documenting a patient with neurologic quadriplegia resulting from a cervical spine injury. However, somewhat less obvious might be functional quadriplegia that results from a patient’s severe weakness. This condition is the inability to move due to disability or frailty caused by another medical condition but not from direct physical injury or damage to the brain or spinal cord (ACP Hospitalist Coding Corner May 2012). Since documentation is focused on the severity of the underlying condition, the result of the condition – functional quadriplegia – is often missed.
Functional quadriplegia is frequently seen in patients with advanced dementia, severe intellectual disabilities, crippling arthritis, advanced multiple sclerosis or amyotrophic lateral sclerosis where the patient lacks full use of their limbs.
Though these patients are often found in skilled nursing facilities, the patient may also be a PACE participant living at home – given PACE’s mission to keep participants at home so they can age in place. Clues to this condition include patients referred to as being “bedfast” or “chairfast.” On a functional level, these patients typically need assistance with all or most of their Activities of Daily Living (ADLs). Clues from the Braden Scale, which is performed to assess the risk of developing pressure ulcers, include the Activity item scored “bedfast” or the Mobility item scored “immobile.” On the other hand, a patient who has a pressure ulcer may have functional quadriplegia as its cause. Another clue would be a care plan that notes that the patient requires a two person transfer or the use of a Hoyer lift.
Proper documentation of functional quadriplegia notes its existence by referencing conditions mentioned above that would also help distinguish it from physical (neurologic) quadriplegia. Remember, listing the diagnosis alone is not enough; for added support you must address how it is to be treated.
Whether the diagnosis is neurological quadriplegia (G82.5-), or functional quadriplegia (R53.2), they both map to HCC 070 – Quadriplegia. The community risk score of 1.075 and institutional risk score of 0.497 for this HCC underscore the high cost associated with these conditions. Therefore, pay attention to those patients who are entering the end stages of their disease. Providing care to these participants is costly. Capturing this diagnosis helps reflect the severity of their condition and provides the revenue so that appropriate care can be administered.