⚕️ICD-10 CM G82.50 - Quadriplegia, unspecified

Code Description

ICD-10 CM G82.50 represents Quadriplegia, unspecified. This code is used to classify paralysis affecting all four limbs and the trunk where the specific level of injury or the specific type (e.g., spastic, flaccid) is not documented or specified. It is often used interchangeably with tetraplegia in clinical documentation.^{CMS ICD-10}

Clinical Overview

Quadriplegia involves impairment or loss of motor or sensory function in the cervical area of the spinal cord. This results in weakness or paralysis in the arms, legs, and trunk. Causes may include traumatic spinal cord injury, stroke, tumors, infections, or congenital conditions. Patients often require assistive devices for mobility and activities of daily living.^NINDS

Coding Hierarchy (Code Tree)

This code exists within the following hierarchy in the ICD-10-CM structure:

Chapter VI: Diseases of the nervous system (G00-G99)
- Block: Cerebral palsy and other paralytic syndromes (G80 - G83)
  - Category: Other paralytic syndromes (G82)
    - Subcategory: Quadriplegia (G82.5)
      - Code: Quadriplegia, unspecified (G82.50)

Official Coding Guidelines & Notes

Includes

This code includes conditions specified as:

Quadriplegia NOS
Tetraplegia NOS^{WHO ICD-10}

Excludes1

Note: Excludes1 means “not coded here”. If the patient has this condition, do not use G82.50. Code the excluded condition instead.

Current traumatic spinal cord injury (S14.1-, S24.1-, S34.1-) - Code the acute injury first.
Congenital or developmental conditions (e.g., Q05.- Spina bifida)^{CMS ICD-10}

Excludes2

Note: Excludes2 means “not included here”. The patient may have both conditions, but code separately.

Cerebral palsy (G80.-)
Hemiplegia (G81.-)
Paraplegia (G82.2-)^{CMS ICD-10}

Coding Tips

Sequelae: If the quadriplegia is a late effect of a previous injury, code the residual condition (G82.50) first, followed by the sequelae code of the injury (e.g., S14.109S).^{Coding Clinic}
Level of Injury: If the level of the spinal cord injury is documented (e.g., C5, C6), use a more specific code from the G82.5 subcategory (e.g., G82.51 Quadriplegia, C1-C4 complete).
Ventilator Dependence: If the patient is dependent on a ventilator, assign code Z99.11 (Dependence on respirator [ventilator]).
Wheelchair Dependence: If applicable, assign code Z99.3 (Dependence on wheelchair).^{CMS ICD-10}

Reimbursement & Risk Adjustment

HCC (Hierarchical Condition Category)

Status: Yes
Model: CMS-HCC V28 (2024 Model)
Category: This code typically maps to HCC categories related to Neurological Conditions or Significant Disability Status. It contributes to the Risk Adjustment Factor (RAF) score.^{CMS Risk Adjustment}
Impact: Accurate documentation of G82.50 is crucial for Medicare Advantage plans to capture the high cost of care associated with permanent paralysis and disability.

wRVU (Work Relative Value Unit)

Value: N/A
Reason: G82.50 is an ICD-10-CM diagnosis code. wRVU values are assigned to CPT/HCPCS procedure codes (e.g., 99214), not diagnosis codes.^{AMA CPT}

Assistant Surgeon Payable

Status: N/A
Reason: Assistant surgeon modifiers (e.g., -80, -81, -82) apply to surgical CPT codes. Diagnosis codes do not have assistant payable status.^{CMS MPFS}

Applicability: Yes
Impact: G82.50 influences DRG assignment when used as a principal or secondary diagnosis in inpatient settings.
MDC: Typically falls under MDC 01 (Diseases and Disorders of the Nervous System) or MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) depending on the admission reason.
CC/MCC: Often qualifies as a Complication or Comorbidity (CC) or Major Complication or Comorbidity (MCC) depending on the presence of complications like pressure ulcers or respiratory failure, increasing DRG weight.^{CMS MS-DRG}

Coding Examples

Example 1: Chronic Sequelae of Trauma

Scenario: A patient presents for routine follow-up of quadriplegia resulting from a car accident 2 years ago. The specific level is not documented in the progress note.

Primary Diagnosis: G82.50 (Quadriplegia, unspecified)
Secondary Diagnosis: Z99.3 (Dependence on wheelchair)
Secondary Diagnosis: S14.109S (Unspecified injury at unspecified level of cervical spinal cord, sequela)
Note: Link the chronic condition to the original injury sequela.^{Coding Clinic}

Example 2: Inpatient Admission for Pressure Ulcer

Scenario: Patient with known quadriplegia is admitted for treatment of a stage 4 sacral pressure ulcer.

Principal Diagnosis: L89.154 (Pressure ulcer of sacral region, stage 4)
Secondary Diagnosis: G82.50 (Quadriplegia, unspecified)
Secondary Diagnosis: Z99.11 (Dependence on respirator [ventilator]) - if applicable
Note: The quadriplegia is a significant comorbidity affecting the DRG.^{CMS MS-DRG}

Example 3: Non-Traumatic Etiology

Scenario: Patient develops quadriplegia due to transverse myelitis.

Primary Diagnosis: G37.3 (Acute transverse myelitis in demyelinating disease of central nervous system)
Secondary Diagnosis: G82.50 (Quadriplegia, unspecified)
Note: Code the underlying disease process first if it is the reason for encounter.^{CMS ICD-10}

While G82.50 does not use modifiers, associated E/M or Procedure codes might:

-25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.
-59: Distinct Procedural Service.
-KX: Requirements specified in the medical policy have been met (often used for therapy services).
-CG: Policy requirement applied to an item or service when reported on a claim (used for PDGM in home health).
-RT / -LT: Right Side / Left Side (if applicable to related procedures).^{AMA CPT}

Sources

^{CMS ICD-10} Centers for Medicare & Medicaid Services, ICD-10-CM Official Guidelines for Coding and Reporting. ^NINDS National Institute of Neurological Disorders and Stroke, Spinal Cord Injury Information Page. ^{WHO ICD-10} World Health Organization, ICD-10 Version:2019. ^{Coding Clinic} AHA Coding Clinic for ICD-10-CM/PCS. ^{CMS Risk Adjustment} CMS Medicare Advantage Risk Adjustment Data Processing System. ^{AMA CPT} American Medical Association, CPT Professional Edition. ^{CMS MPFS} CMS Medicare Physician Fee Schedule. ^{CMS MS-DRG} CMS Medicare Severity Diagnosis Related Groups Definitions Manual.

Explorer

G82.50