G82.21

🧬 ICD-10 CM G82.21 — Paraplegia, complete

Billable Code Confirmed

ICD-10 CM G82.21 is a valid, billable 5-character ICD-10-CM code for FY2025. All five characters are present: G82 (category) + .2 (paraplegia) + 1 (complete). No 7th character is required.

Non-Billable Parent Codes — Never Submit These

• ❌ G82 — 3-character header — missing subcategory and specification

• ❌ G82.2 — 4-character header — missing completeness specification

  Always submit G82.21 (or G82.20/G82.22) when paraplegia is documented to specify the severity/completeness of the paralysis.

Clinical Context: Sequencing and "Code First" Rules

ICD-10 CM G82.21 is often used as a secondary code to identify the neurological deficit resulting from another underlying cause. The G82 category notes state it should be used in multiple coding to identify these conditions resulting from any cause. If the paraplegia is due to an acute spinal cord injury, you must code first the acute spinal cord trauma (e.g., S14.-, S24.-, S34.-). If it is a sequela of an old injury, you code the late effect first.

🔍 Code Description

ICD-10 CM G82.21 classifies complete paraplegia, which is the total loss of voluntary motor function and sensory perception in the lower half of the body, including both legs and often the lower trunk.

This condition typically results from severe damage to the spinal cord below the level of the first thoracic nerve (T1), leaving the arms and hands fully functional. Common etiologies include:

• Traumatic spinal cord injuries (motor vehicle accidents, falls)
• Spinal tumors or metastases
• Spina bifida
• Transverse myelitis
• Spinal cord infarction (stroke of the spinal cord)

Note

To code G82.21, the provider must explicitly document the paraplegia as “complete.” If the record just states “paraplegia” without specifying complete or incomplete, default to G82.20 (Paraplegia, unspecified).

🌳 Code Tree / Hierarchy

G82 Paraplegia (paraparesis) and quadriplegia (quadriparesis) ❌ Non-billable
│  
├── G82.2 Paraplegia ❌ Non-billable
│ │  
│ ├── G82.20 Paraplegia, unspecified
│ ├── G82.21 PARAPLEGIA, COMPLETE ◀ THIS CODE ✅
│ └── G82.22 Paraplegia, incomplete
│
└── G82.5 Quadriplegia ❌ Non-billable

✅ Includes

The following clinical scenarios and terms map to G82.21:

• Complete paralysis of both lower limbs
• Complete paraparesis (though paraparesis often implies incomplete, if stated as complete loss of function, it maps here)
• Paraplegia (complete) as a late effect of stroke or spinal trauma

❌ Excludes

Excludes1 — Cannot be coded together

The Excludes1 note dictates that the following conditions cannot be coded alongside G82.21. They represent distinct pathophysiologic pathways:

• Congenital cerebral palsy (G80.0-G80.9)
• Functional quadriplegia (R53.2)
• Hysterical paralysis (F44.4)

🛠️ CPT Procedural Crosswalk — wRVU & Assistant Payable Status

Patients with G82.21 frequently require intensive PM&R, complex E/M management, or procedures like baclofen pump management for severe spasticity. Below are common procedural CPT codes paired with G82.21.

CPT Code	Description	Global Period	wRVU (Facility)	Asst. Surgeon Payable?	Bundling & NCCI Edits
99214	Office or other outpatient visit, established patient, moderate complexity	XXX	1.92	No (Indicator 0)	Often mutually exclusive with minor procedures unless a significant, separately identifiable E/M is performed (requires modifier -25).
97110	Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises	XXX	0.45	No (Indicator 0)	Standard PM&R code. Bundles into physical therapy evaluations if not billed carefully with modifiers.
62362	Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump	090	~17.50	Yes (Indicator 2) — Justification required	Major surgery for severe spasticity. Co-surgeon (Indicator 0).
95990	Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural)	XXX	1.25	No (Indicator 0)	Mutually exclusive with most E/M visits unless the E/M is distinct and separately identifiable.

Note: wRVU values are estimates based on the standard CMS Physician Fee Schedule. Check current year exact values.

💊 Coding Scenarios

Scenario 1 — Sequela of Spinal Cord Injury (Outpatient Rehab)

Clinical Vignette: A 45-year-old male with a history of an L1 burst fracture 5 years ago presents to the PM&R clinic for a follow-up. He has complete loss of motor and sensory function below the waist. He is wheelchair-bound and requires an adjustment to his home physical therapy program. He undergoes a 40-minute moderate-complexity evaluation and management visit.

CPT / HCPCS:

• 99214 — Office/outpatient visit, est. patient, moderate complexity

ICD-10-CM:

• G82.21 — Paraplegia, complete (Identifies the current neurologic deficit)
• S34.109S — Unspecified injury to lumbar spinal cord, sequela (Provides the historical etiology of the paraplegia)
• Z99.3 — Dependence on wheelchair (Supplemental status code)

Scenario 2 — Baclofen Pump Refill for Spasticity

Clinical Vignette: A 30-year-old female with complete paraplegia resulting from prior transverse myelitis presents for a scheduled refill of her intrathecal baclofen pump. She has severe lower extremity spasticity. The physician accesses the pump, aspirates residual drug, programs the new dose, and refills the reservoir.

CPT / HCPCS:

• 95990 — Refill and maintenance of implantable pump, spinal
• J0475 — Injection, baclofen, intrathecal, per 10 mg (HCPCS code for the medication itself)

ICD-10-CM:

• Z46.2 — Encounter for fitting and adjustment of other nervous system device (Primary reason for the encounter)
• G82.21 — Paraplegia, complete (Underlying condition causing spasticity)
• G89.4 — Chronic pain syndrome (If applicable based on documentation)

⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Do not code G82.21 for acute injuries as the principal diagnosis: If the patient is admitted for acute management of a traumatic spinal cord injury (e.g., falling off a roof resulting in a T12 complete transection), code the acute trauma (e.g., S24.-) first. G82.21 is added as a secondary code.
❌	Do not assume “Complete”: If the physician writes “Patient has paraplegia,” you cannot infer it is complete. You must use G82.20 (Unspecified) unless you query the provider or find “complete” explicitly documented elsewhere in the chart.
✅	Capture for HCC Risk Adjustment: G82.21 carries a significant risk score. Even if the patient is being seen for an unrelated issue (e.g., a respiratory infection), if the paraplegia impacts their care plan (e.g., requires transfer assistance, alters medication choices), document it and code it as a secondary diagnosis to accurately reflect the patient’s complexity.
✅	Use Status Codes: Always remember to append codes like Z99.3 (Dependence on wheelchair) or Z43.5 (Encounter for attention to cystostomy) if the patient requires these devices due to their complete paraplegia.

📚 Sources

1. CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2025. Tabular List — G82 Category instructions.
2. American Medical Association (AMA). CPT 2024/2025 Professional Edition.
3. CMS HCC Risk Adjustment Model V28 category mappings.