functional quad.

laura.jansen

I have a patient with post polio syndrome that requires total care due to the problem. He has contractures, muscle atrophy, & generalized debility. I was wondering If a query for functional quadriplegia would be appropriate. I am not that familiar with post polio syndrome or the functional quadriplegia but I want to capture his severity of illness. I found this coding clinic:

Functional Quadriplegia
Coding Clinic 4th Qtr. 2008, p. 143

Functional quadriplegia is not a true paresis. It is the inability to move due to another condition (e.g., dementia, severe contractures, arthritis, etc.). The patient is immobile because of a severe physical disability or frailty. There is usually some underlying cause, which most often will involve severe dementia. The individual does not have the mental ability to ambulate and functionally is the same as a paralyzed person.

Instructional notes in the Tabular indicate that neurologic quadriplegia (344.00-344.09), hysterical paralysis (300.11) and immobility syndrome are excluded from code 780.72.



Any thoughts would be appreciated.

mary.a.dunn

I would certainly query for quad. Regardless of the cause of the quad, it is still an MCC. I had a pt that had an old gunshot wound which left him a quad and I got the MCC. Go for it.

mary.a.dunn

I have been told that severe contractures of 3 or more extremities qualifies as a quad

stacy.vaughn

Just remember to word your query in a way that it is not leading.

Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052

dbutler

Sounds like a very appropriate query to me -- just the type of patient this code is intended for.

Don

debbie.taylor

I had a patient that had severe dementia. The physician had documented in the H&P that the patient was bed ridden D/T the severe dementia and was totally dependent upon the wife for his care. I discussed the diagnosis of functional quadriplegia with the physician and he agreed to this diagnosis. Since then he has used one other time with another patient.
A thought -I believe with this patient the severe contractures & muscle atrophy would meet this along with documentation regarding being immobile R/T these conditions.

digardsk

I would be cautious in querying for functional quadriplegia if there was an underlying neurologic cause with the impairment an expected part of the condition. To me, this is really talking about a lack of mobility due to extreme frailty with a dementia. Kim

cstukenberg

So for functional quad do you need a neuro diagnosis or can documentation of multiple contractures and total care pt be enough???

kmaritan

Reading the definitions and tip for functional quad 780.72 answers all the questions posed so far. Thanks for opening up this new diagnosis for clarification opportunities. I never would have considered this diagnosis or need for a clarification and it is an MCC. Thanks again.
Karen Maritano, RN
Clinical Documentation Improvement Specialist
Care Management
Legacy Health
phone 503-413-7154
pager 503-983-0683

digardsk

I usually don't ask about funct quad if there is a neuro dx that is causing the mobility impairment. I would ask for sure if there are contractures and dementia.

kmaritan

That's what the definition for 780.72 explains.

lspryszak

Something else to consider in addition to the functional quadriplegia:
"late effect of polio"

Late effect - guidelines
Coding Clinic, March - April 1986 Page: 5 to 6
Late Effect

A late effect is the residual effect (condition produced) alter the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. The classification provides only a few codes for cause of late effect, and they are as follows:



137.0-137.4 Late effects of tuberculosis
138 Late effects of acute poliomyelitis
139.0-139.8 Late effects of other infectious and parasitic diseases
268.1 Rickets, late effect
326 Late effects of intracranial abscess or pyogenic infection
438 Late effects of cerebrovascular disease
905.0-905.9 Late effects of musculoskeletal and connective tissue injuries
906.0-906.9 Late effects of injuries to skin and subcutaneous tissues
907.0-907.9 Late effects of injuries to the nervous system
908.0-908.9 Late effects of other and unspecified injuries
909.0-909.9 Late effects of other and unspecified external causes
Coding of late effects requires two codes:

• The residual condition or nature of the late effect

• The cause of the late effect

The residual condition or nature of the late effect is sequenced first, followed by the cause of the late effect, except in those few instances where the code for late effect is followed by a manifestation code identified in the Tabular List as an italicized code and title.

The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the cause of the late effect.

If the External Causes of Injury and Poisoning codes (E codes) are routinely used, page 891 in Volume 2 lists the late effect E codes that may be used. Notice that there are no late effect E codes for infectious conditions.

Examples

• Traumatic arthritis, right ankle, resulting from previous fracture of right ankle due to a
motor vehicle accident

716.17
905.4
E929.0 (optional code)


• Osteoarthritis of hip secondary to hip fracture five years ago

715.25
905.3


• Scoliosis resulting from previous episode of poliomyelitis (sequencing exception)

138
737.43


• Equinovarus deformity, progressive, due to old injury to common peroneal nerve

736.71
907.5

• Polio residuals (not otherwise specified)

138

mary.a.dunn

Good morning,
Does anyone out there have a query for functional quadriplegia. We are struggling to construct one that is instructional to the physicians yet not too long. Can anyone out there help

catladyrn

If you log onto the group through the list manager, you can search the archives, and you will see that someone answered this very question only a short time ago. I find the list manager format easier than trying to follow individual emails, and I can look to see if a topic's already been discussed.

Personally, I have never queried functional quadriplegia.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

clungrin

I'm a new user....how do you log onto the list manager?

catladyrn

It's through the ACDIS website. If you go to CDI Talk, you can log in there.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

vodoms

Hello Everyone, 

Can someone please tell me if I can query for FQ in the following conditions below:

Multiple Sclerosis

Cancer

Myasthenia gravis

ALS

CVA

Dementia

Brain death from anoxia

Arthritis

Thanks, 
CDI MMC, Bronx

bbogda@morrishospital.org

Here is some helpful info from our vendor.  Based on this info I would say yes to all of the above.  Brain death? - the patient's dead.... 

R53.2 Functional quadriplegia

Excludes1:

frailty NOS (R54)
hysterical paralysis (F44.4)
immobility syndrome (M62.3)
neurologic quadriplegia (G82.5-)
quadriplegia (G82.50)

InclusionTerm:  Complete immobility due to severe physical disability or frailty

Functional Quadriplegia

ICD-10-CM Official Guidelines for Coding and Reporting

C. Chapter-Specific Coding Guidelines

18. Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)

• Chapter 18 includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded. Signs and symptoms that point to a specific diagnosis have been assigned to a category in other chapters of the classification.
• Functional quadriplegia
• Functional quadriplegia (code R53.2) is the lack of ability to use one's limbs or to ambulate due to extreme debility. It is not associated with neurologic deficit or injury, and code R53.2 should not be used for cases of neurologic quadriplegia. It should only be assigned if functional quadriplegia is specifically documented in the medical record. 

From another source: https://acphospitalist.org/archives/2012/05/coding.htm

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.