Question: The CDI Pocket Guide® and several other sources have different descriptions of functional quadriplegia. Other sources indicate it is from another medical condition: "without physical injury or damage to the brain or spinal cord." The CDI Pocket Guide® indicates: "without physical injury or damage to the spinal cord." It does not mention "brain."

A NIH.gov article "Functional Quadriplegia as an Initial Presentation of Severe Rheumatoid Arthritis" states: "According to the International Classification of Diseases-10, functional quadriplegia (FQ) is defined as the 'complete immobility due to severe disability or frailty from another medical condition without injury to the brain or spinal cord.'"

According to ICD-10 Monitor: "Functional quadriplegia, ICD-10-CM code R53.2, is defined as being 'complete immobility due to severe disability or frailty caused by another medical condition, without physical injury or damage to the brain or spinal cord.'"

Per the Pinson & Tang CDI Pocket Guide®: "Functional quadriplegia (R532) is the lack of ability to use one’s limbs or to ambulate due to extreme debility or frailty caused by another medical condition without physical injury or damage to the spinal cord."

Answer:  We do not include “brain” in the definition of functional quadriplegia for the following reasons:

The ICD-10-CM classification describes functional quadriplegia (code R53.2) as "complete immobility due to severe physical disability or frailty." This code is not assigned (Excludes 1) if neurologic quadriplegia (G82.5-), which is due to spinal cord injury, immobility syndrome (M62.3), hysterical paralysis (F44.4), or frailty NOS (R54).

We added the phrase "caused by another medical condition without physical injury or damage to the spinal cord" when we included this key diagnosis in the CDI Pocket Guide® to clarify the difference between a neurological, or structural, quadriplegia and the term “functional” quadriplegia.

As for the two references provided:

• The ICD-10 Monitor article, authored by Dr. Erica Remer, includes the ICD-10-CM description but adds in her own words: "from another medical condition without injury to the brain or spinal cord."
• The NIH article "Functional Quadriplegia as an Initial Presentation of Severe Rheumatoid Arthritis" merely quotes Dr. Remer’s definition.

Neurological or structural quadriplegia is almost always due to trauma to the cervical spinal cord or, less often, the brain stem. Trauma to higher levels of the brain rarely causes structural quadriplegia, although the degree of brain injury may result in functional quadriplegia.

Including "without physical injury or damage to the brain" might infer that functional quadriplegia cannot occur with severe brain injury/damage, severe end-stage dementia, advanced neurodegenerative disorders, or other non-spinal cord injuries, which are noted as causes in our CDI Pocket Guide®.