ICD-10 Coding for Spasticity(G25.82, G80.1)
Complete ICD-10-CM coding and documentation guide for Spasticity. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Spasticity
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G25.82 | Spasticity | Use when spasticity is present without a more specific underlying condition identified. |
|
| G80.1 | Spastic diplegic cerebral palsy | Use when spasticity is due to spastic diplegic cerebral palsy. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for spasticity
Essential facts and insights about Spasticity
Primary ICD-10-CM Codes for spasticity
Decision Criteria
clinical Criteria
- Presence of velocity-dependent muscle resistance
documentation Criteria
- Documented Modified Ashworth Scale score
Applicable To
- Unspecified spasticity
Clinical Validation Requirements
- Modified Ashworth Scale score
- EMG showing velocity-dependent hyperreflexia
- MRI showing CNS lesions
Code-Specific Risks
- Incorrectly using as a primary diagnosis without identifying an underlying cause.
Coding Notes
- Ensure documentation supports the use of G25.82 by detailing spasticity characteristics and any underlying conditions.
G80.1 - Spastic diplegic cerebral palsy
Use when spasticity is due to spastic diplegic cerebral palsy.
Applicable To
- Spastic diplegia
Excludes
- Other forms of cerebral palsy
Clinical Validation Requirements
- MRI confirming spastic diplegia
- Clinical history of bilateral lower extremity involvement
Coding Notes
Ensure the type of cerebral palsy is clearly documented to avoid coding errors.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Hypertonia
R29.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Spasticity to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G25.82.
Impact
Clinical: Inaccurate treatment planning., Regulatory: Potential for audit and compliance issues., Financial: Loss of reimbursement due to incorrect coding.
Mitigation Strategy
Always assess and document potential underlying conditions., Use diagnostic tests to confirm etiology.
Impact
Reimbursement: Incorrect sequencing can lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines may result in audits., Data Quality: Inaccurate data collection affecting patient records and statistics.
Mitigation Strategy
Always code the underlying condition first if known.
Impact
Failure to sequence underlying conditions before spasticity can trigger audits.
Mitigation Strategy
Educate coding staff on proper sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Spasticity, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Spasticity
Use these documentation templates to ensure complete and accurate documentation for Spasticity. These templates include all required elements for proper coding and billing.
Spasticity due to multiple sclerosis
Specialty: NeurologyRequired Elements
- Underlying condition
- Spasticity severity
- Affected muscles
- Functional impact
- Treatment response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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