"Functional Quadriplegia"

afulmer

I would like to educate our physicians on the use of "functional quadriplegia" as a diagnosis when a patient is dependent for ADL's. It would help if I could provide them with physician supported literature to support its use as an appropriate diagnosis.

Any suggestions?

mdominesey

According to the "Just Coding" article provided by HCPro at http://www.hcpro.com/HIM-240399-3288/Understand-the-complexity-of-coding-for-conditions-that-arent-named-in-documentation.html

It is not really necessary for physicians to write "functional quadriplegia" for coders to code it as a diagnosis. The patient must meet the guidelines for someone who is functionally quadriplegic such as requiring total care, contractures all four limbs, total assist/bedbound, cognitively unable to participate in their care, or several other qualifiers.

That being said, I also have undertaken physician education regarding the diagnosis of "functional quadriplegia". I believe that the medical record is most solid and irrefutable when we can get the physician to supply the diagnosis and it is not as strong when we have to infer a diagnosis in very limited circumstances such as this one.

Cheers!

Mark


Mark N. Dominesey, RN, BSN, MBA, CCDS
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
W: 202.660.6782
http://www.sibley.org

kara.masucci

HI

I tried to find a journal article as well -- but, couldn't (will
continue quest when I have time and forward what I can find).

But, the article Mark sent is what I use to reference, as well, when
speaking w/ docs. Basically, (from my understanding) the individual does
not have the mental ability to ambulate and functionally is the same as
a paralyzed person.

Good luck!
Kara

mdominesey

I feel it necessary to clarify what I wrote earlier.

This is a potential auditable diagnosis in the near future much like "Acute Respiratory Failure" is now. We should ALWAYS query the physician/LIP to get the diagnosis recorded in the medical record and not expect it to be coded without it being present in the record. My practice is just that. Physician education is key and we should not be introducing a new diagnosis, but getting them to name a condition that they are already treating. Education prior to our encounter for the record review is very important.

Mark

catladyrn

Dr. Gold wrote about functional quadriplegia here:

http://www.cditalk.com/content/257-You-Can’t-Get-Credit-for-Everyone’s-Trouble-without-Documenting-Its-Existence

Renee


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

[Deleted User]

Members of the ACDIS Advisory Board provide some insight in an Q&A that will be published in the January edition of the CDI Journal. E-mail me at mvarnavas@cdiassociation.com, Mark, and I'll explain further.

afulmer

It has been my experience that it is difficult to reach this as a "final diagnosis" while following the 3M Coder/ICD-9 coding guidelines without specific documentation of "functional quadriplegia. That is what prompted my inquiry to ACDIS.

The physician clearly described a patient completely dependent for all ADL's. With my nursing background I did not feel the final DRG reflected the demand that this patient put on the hospital staff nor the higher morbidity/mortality risk. This triggered my research of the MCC list for diagnoses that might support this type condition. Once I located this specific diagnosis I research it in detail and found that it described my patient perfectly.

My goal was to reflect the patient's true SOI/ROM.

Any suggestions on how to better address this while keeping all rules and regulations in check?


Joan Fulmer