Introducing Functional Quadriplegia

Erica E. Remer, MD, FACEP, CCDS

My first day of orientation as a CDI physician advisor my patients became instantly sicker. The director of CDI taught me about certain conditions which I didn’t previously recognize or document in the ED. These included encephalopathy, malnutrition, and today’s topic, functional quadriplegia.

I had never heard of this condition before because it is essentially a coding construct. The term indicates a patient who is completely immobile due to severe disability or frailty without physical injury or damage to the brain or spinal cord. Examples of patients with functional quadriplegia are advanced dementia patients who need assistance for all of their activities of daily living and super obese patients (BMI ≥ 50) who are unable to ambulate and care for themselves.

There are folks in the CDI world who think this is just a made-up diagnosis and is a grab to procure a major comorbid condition or complication. I disagree. I always knew this type of patient was sicker, more complex, and/or required more nursing care than other patients with similar underlying conditions without functional quadriplegia. I just didn’t have a way to indicate this in diagnoses or codes. Personally, I welcomed the terminology.

The ACPA CDI Committee recently created information on functional quadriplegia for the physician advisor and a CDI tip for the provider. You can access it on the CDI Resource Page under MDC 1. It would be extremely unlikely to ever be the principal diagnosis establishing the Diagnosis Related Group (DRG), so it is just for ease of locating it that we posted it under the Nervous System.

Please check it out! If you have any CDI topics for which you would like materials created, please reach out to us at [email protected]. We are always looking for our next project.