Skip to main content

R53.2 ICD-10-CM Code: Functional quadriplegia

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 5 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 70

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 947 — SIGNS AND SYMPTOMS WITH MCC (MDC 23)
  • MS-DRG 948 — SIGNS AND SYMPTOMS WITHOUT MCC (MDC 23)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 180 — Quadriplegia (supersedes HCC 181, HCC 182, HCC 253, HCC 254)

Other models: CMS-HCC V22 HCC 70

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R53.2 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Complete immobility due to severe physical disability or frailty

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Coder workflow for R53.2

MedCoder structured workflow — derived from this code’s own official record

Before you code R53.2

  1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

    Guide: Symptom code vs confirmed diagnosis →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with R53.2. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Is an established diagnosis that explains this sign or symptom documented?
    Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
    No → Continue — the sign or symptom code stands when no definitive diagnosis is established.
  2. Does the documentation support a condition named in R53.2’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewR54, F44.4, M62.3, G82.5, G82.50

Consider R53.2. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting R53.2(5 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with R53.2: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareR54, F44.4, M62.3, G82.5, G82.50

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The sign or symptom is documented, and the same record establishes a diagnosis that routinely includes it.

Coding question: Is R53.2 reported in addition to the diagnosis?

Path: Review the documented diagnosis and whether the classification treats this finding as integral to it.

Reason: Signs and symptoms integral to a confirmed diagnosis are not coded separately; those not routinely associated with it may be reported when present (Guidelines I.B.5, I.B.6, I.C.18.b).

Documentation: Both the condition R53.2 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewR54, F44.4, M62.3, G82.5, G82.50

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Functional quadriplegia is a billable ICD-10-CM diagnosis code (R53.2).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name R53.2 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: G82 — Paraplegia (paraparesis) and quadriplegia (quadriparesis).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 136 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 947 (MDC 23), DRG 948 (MDC 23).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM010 — Nervous system signs and symptoms (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

G83.82 — Anterior cord syndrome, G83.83 — Posterior cord syndrome, G83.84 — Todd's paralysis (postepileptic), G83.89 — Other specified paralytic syndromes, G83.9 — Paralytic syndrome, unspecified, G90.1 — Familial dysautonomia [Riley-Day], G93.81 — Temporal sclerosis, G93.89 — Other specified disorders of brain, G93.9 — Disorder of brain, unspecified, G96.9 — Disorder of central nervous system, unspecified, G98.0 — Neurogenic arthritis, not elsewhere classified, G98.8 — Other disorders of nervous system, Q06.0 — Amyelia, Q06.1 — Hypoplasia and dysplasia of spinal cord, Q06.3 — Other congenital cauda equina malformations, Q06.8 — Other specified congenital malformations of spinal cord, Q06.9 — Congenital malformation of spinal cord, unspecified, Q07.8 — Other specified congenital malformations of nervous system, Q07.9 — Congenital malformation of nervous system, unspecified, Q87.88 — CTNNB1 syndrome, +115 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Quadriplegia) for risk-adjusted payment.

G82.50 — Quadriplegia, unspecified, G82.51 — Quadriplegia, C1-C4 complete, G82.52 — Quadriplegia, C1-C4 incomplete, G82.53 — Quadriplegia, C5-C7 complete, G82.54 — Quadriplegia, C5-C7 incomplete, S14.111A — Complete lesion at C1 level of cervical spinal cord, initial encounter, S14.111D — Complete lesion at C1 level of cervical spinal cord, subsequent encounter, S14.111S — Complete lesion at C1 level of cervical spinal cord, sequela, S14.112A — Complete lesion at C2 level of cervical spinal cord, initial encounter, S14.112D — Complete lesion at C2 level of cervical spinal cord, subsequent encounter, S14.112S — Complete lesion at C2 level of cervical spinal cord, sequela, S14.113A — Complete lesion at C3 level of cervical spinal cord, initial encounter, S14.113D — Complete lesion at C3 level of cervical spinal cord, subsequent encounter, S14.113S — Complete lesion at C3 level of cervical spinal cord, sequela, S14.114A — Complete lesion at C4 level of cervical spinal cord, initial encounter, S14.114D — Complete lesion at C4 level of cervical spinal cord, subsequent encounter, S14.114S — Complete lesion at C4 level of cervical spinal cord, sequela, S14.115A — Complete lesion at C5 level of cervical spinal cord, initial encounter, S14.115D — Complete lesion at C5 level of cervical spinal cord, subsequent encounter, S14.115S — Complete lesion at C5 level of cervical spinal cord, sequela, +12 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Paraplegia, Spinal Cord Disorders/Injuries, Hemiplegia/Hemiparesis, Monoplegia, Other Paralytic Syndromes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Nervous system signs and symptoms).

R43.1 — Parosmia, R43.2 — Parageusia, R43.8 — Other disturbances of smell and taste, R43.9 — Unspecified disturbances of smell and taste, R47.01 — Aphasia, R47.02 — Dysphasia, R47.1 — Dysarthria and anarthria, R47.81 — Slurred speech, R47.82 — Fluency disorder in conditions classified elsewhere, R47.89 — Other speech disturbances, R47.9 — Unspecified speech disturbances, R48.0 — Dyslexia and alexia, R48.1 — Agnosia, R48.2 — Apraxia, R48.3 — Visual agnosia, R48.8 — Other symbolic dysfunctions, R48.9 — Unspecified symbolic dysfunctions, R51 — Headache, R51.0 — Headache with orthostatic component, not elsewhere classified, R51.9 — Headache, unspecified, +138 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Immobile, immobility”, “Quadriplegia”; these codes share that main term but sit in a different category of the Tabular List.

G80.0 — Spastic quadriplegic cerebral palsy (congenital, spastic), G80.8 — Other cerebral palsy (congenital), G82.50 — Quadriplegia, unspecified, G82.51 — Quadriplegia, C1-C4 complete (complete, C1-C4 level), G82.52 — Quadriplegia, C1-C4 incomplete (incomplete, C1-C4 level), G82.53 — Quadriplegia, C5-C7 complete (complete, C5-C7 level), G82.54 — Quadriplegia, C5-C7 incomplete (incomplete, C5-C7 level), I63.3 — Cerebral infarction due to thrombosis of cerebral arteries (thrombotic), I63.4 — Cerebral infarction due to embolism of cerebral arteries (embolic), K59.89 — Other specified functional intestinal disorders (intestine), M62.3 — Immobility syndrome (paraplegic) (syndrome)

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Fecal Occult Blood Test (FOBT), Hepatitis Testing, Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of R53.2 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run R53.2 with these 6 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 180 — Quadriplegia [CMS-HCC]: “Quadriplegia — supersedes HCC 181 (Paraplegia), HCC 182 (Spinal Cord Disorders/Injuries), HCC 253 (Hemiplegia/Hemiparesis), HCC 254 (Monoplegia, Other Paralytic Syndromes)”— CMS-HCC V28 · 2026

MS-DRG Grouper

  • MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 947 — SIGNS AND SYMPTOMS WITH MCC[MS-DRG]: “SIGNS AND SYMPTOMS WITH MCC (MDC 23)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
  • DRG 948 — SIGNS AND SYMPTOMS WITHOUT MCC[MS-DRG]: “SIGNS AND SYMPTOMS WITHOUT MCC (MDC 23)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

  • MDC 23 — Factors Influencing Health Status and Other Contacts with Health Services[MDC crossing]: “Factors Influencing Health Status and Other Contacts with Health Services — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,235 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Immobile, immobility, complete, due to severe physical disability or frailty[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Quadriplegia, functional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "R53.2 — Functional quadriplegia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/r53.2-functional-quadriplegia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Functional quadriplegia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R53.2 in its code family, with their registry titles.

View all codes in the R53 family