Tuesday, January 26, 2021

Hemiplegia, Paraplegia, Quadriplegia

Hemiplegia.  Paraplegia.  Quadriplegia.  Three similar terms in that they all refer to paralysis, yet different as they describe the parts of the body that are affected, and in this segment of “In the kNOW”, we’ll explore these differences and the coding related to these conditions. 

Let’s begin with hemiplegia, which is a state of partial or complete paralysis affecting only one side of the body.  The most common cause of hemiplegia is a stroke, but other conditions may also cause hemiplegia.  Spinal cord injuries as a result of trauma, brain tumors or aneurysms, infections that affect the brain, as well as conditions such as amyotrophic lateral sclerosis can all result in hemiplegia.  Symptoms can include severe loss of muscle strength or paralysis, difficulty walking or keeping one’s balance, loss of fine motor skills, or keeping one hand fisted.

It’s worth noting that hemiparesis is a milder form of hemiplegia.  Although the loss of muscle strength is not as severe with hemiparesis, the Alphabetical Index of ICD-10-CM directs coding professionals to the term Hemiplegia when they look up Hemiparesis. 

In ICD-10-CM, category G81 covers hemiplegia and hemiparesis providing three distinct subcategories; flaccid, spastic, or unspecified.  Flaccid hemiplegia refers to paralysis with decreased muscle tone; spastic hemiplegia identifies paralysis with increased muscle tone (constant contraction); and unspecified indicates that no distinction has been made regarding the type of hemiplegia.  To appropriately assign the code for a hemiplegic condition, the coding professional must further determine which side of the body the paralysis affects and identify if the affected side is the patient’s dominant or non-dominant side.  Official Coding Guideline I.C.6.a provides the necessary information for assisting coding professionals in determining dominance when the documentation does not specify it and a default has not been provided in ICD-10-CM.  The guidance indicates the following:

  • Right side impacted-code as dominant
  • Left side impacted-code as non-dominant
  • For ambidextrous patients-code as dominant

To apply the guidance, review this scenario.  A patient comes in with left-sided muscle weakness which in the final diagnostic statement is documented as flaccid hemiplegia.  In the consultation report by the neurologist (which is often where coding professionals will find a description of dominance), she notates that the patient is left-handed.  The proper code assignment will be G81.02, flaccid hemiplegia affecting left dominant side. 

Paraplegia is partial or complete paralysis of the lower body.  This condition impacts both legs and is usually due to an injury at the lumbar or thoracic level of the spinal cord.  Paraplegia is located in ICD-10-CM in subcategory G82.2 with the fifth digit designation identifying if the condition is complete, incomplete, or unspecified.

Spinal cord injuries are considered complete when the spinal cord has been totally severed or compressed, which effectively eliminates the brain’s ability to send or receive signals below the injured area. Patients with incomplete spinal cord injuries retain some function/feeling below the injury site with symptoms varying widely depending on the injury.

Quadriplegia is partial or complete paralysis of both arms and legs generally as a result of injury or disease of the cervical spinal cord.  This is reflected in the code choices for quadriplegia which fall into subcategory G82.5 with the fifth digit signifying cervical spinal level involvement (C1-C4 or C5-C7) and whether the injury is complete or incomplete.

Two additional points.  First a reminder, that hemiplegia that is a sequela of a stroke should be coded to the appropriate I69 category.  Second, the condition known as functional quadriplegia is coded under signs and symptoms with code R53.2.  That is because functional quadriplegia is not a true paralysis but rather the inability to move due to a nonphysiological condition such as severe dementia.  This is supported in a Fourth Quarter Coding Clinic from 2008.

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.