Question about functional quadriplegia

Comments

• katysuegood@gmail.com

  August 2012 edited May 2016

  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

  August 2012

  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

  August 2012 edited May 2016

  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

  August 2012 edited May 2016

  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