Question about functional quadriplegia

nursronnam

Hello all,

I see that this has been a topic recently and I had something come up last week that I would like your opinion on. We currently use the encoder when identifying our DGR. Complete immobility leads to a diagnosis of functional quadriplegia so my staff believe the documentation of complete immobility is sufficient to code it. I have reviewed the query in the ACDIS query section and it identifies incomplete mobility and a symptom documented in the chart that needs further clarification. What are your thoughts on this. I want to make sure I have the correct informatio to take back to my staff.

Ronna Mahlen, RN, BSN, C-CDS
Valley Medical Center, Renton, WA
ronna_mahlen@valleymed.org

katysuegood@gmail.com

We clarify "complete immobility". In my opinion, a patient could have complete immobility after surgery or a traumatic accident but not be a "functional quadriplegic". Functional quadriplegia is a very tough diagnosis and unfortunately, it is difficult to define. However, how I see it, is that it should be used when we are talking about long-term/permanent immobility. This would be appropriate in severe dementia, severe contractions, terminal illness, etc. However, I realize there may be other interpretations. We require the actual stating of "functional quadriplegia" for coding and even with that I am often uncomfortable because I routinely see it used inappropriately.
I'm curious what others have to say on the actual clinical criteria of the diagnosis.

Thanks!


Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

nursronnam

Katy,

I total agree with you about having the actual documentation of functional quadriplegia in the record. Since it is a difficult diagnosis to define I think we are better to have the actual documentation.

robert.hodges2

Here are a couple of references I have on functional quadriplegia. I hope they help

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
“Patriotism is easy to understand in America; it means looking out for yourself by looking out for your country" Calvin Coolidge

evanspx@sutterhealth.org

I can't attach due to length of my form, but here is a query form and some definitions - the formatting has been affected when I post.



Request for Clarification – “Total or Near Total Care Patients”


Dear Physician/PA/NP: ____________________________________________________________________ or other responsible provider:
For accurate coding and severity-of-illness compilation, this query is directed to you. When responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.
Thank you, on behalf of Allan Pont, MD, Vice President of Medical Affairs

On_________ documentation in the __________________________________ the following symptoms/descriptions/diagnoses are documented:


0 Severe Dementia
0 Total Care/Maximum Assist
0 Contractures
0 Immobility/Debility

0 Bed-Bound 0 Other:____________________________






Please indicate the nature of the patient’s condition, if feasible.

CDI Specialist/Coder: _________________________________ Date:_____________ Time: _______________


PHYSICIAN/PA/NP (Check all that apply):

0 Functional Quadriplegia
0 Critical Illness Myopathy
0 Critical Illness Polyneuropathy
0 General Debility/Deconditioning
0 Other: Specify: __________________________________
0 None of the above


Physician/PA/NP Printed Name:______________________________________________________________________

Physician/PA/NP Signature: _____________________________________________Date: __________Time:_______







Definitions:

Functional quadriplegia: Functional quadriplegia (or quadriparesis) is defined as the complete inability to move due to severe disability or frailty caused by another medical condition without physical injury or damage to the brain or spinal cord. Patients usually do not have the mental ability to move themselves and require “total care,” such as turning every one or two hours and full assistance with feeding, elimination and hygiene.
The most common cause of functional quadriplegia is advanced neurologic degeneration from dementia, hypoxic injury, amyotrophic lateral sclerosis, Huntington's disease, multiple sclerosis or similar conditions. However, some birth defects or advanced musculoskeletal deformity (including severe, progressive arthritis) may result in functional quadriplegia (Used with Permission: May ACP Hospitalist, copyright © 2012 by the American College of Physicians, author: Richard Pinson, MD, FACP) used with permission

Critical Illness myopathy: Also known as acute quadriplegic myopathy. Develops in a patient in the intensive care setting and is often discovered when a patient is unable to be weaned off a ventilator. The cause of the diffuse weakness is prolonged daily use of either (often both) high-dose intravenous glucocorticoids (usually methylprednisolone) or nondepolarizing neuromuscular blocking agents. (Goldman: Cecil Medicine, 23rd ed.2007)

Critical illness polyneuropathy: An acute or subacute axonal length-dependent neuropathy that occurs in critically ill patients, not as a direct consequence of their underlying illness. The neuropathy is monophasic and recovers, at least in part, if the patient survives the underlying illness. (Goldman's Cecil Medicine, 24th ed.)


Paul Evans, RHIA, CCS, CCS-P, CCDS

Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org