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v1.0.0
ICD-10 Guide
ICD-10 CodesG81.1

G81.1

Billable

Spastic hemiplegia

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G81.1 is a billable code used to indicate a diagnosis of spastic hemiplegia.

Key Diagnostic Point:

Spastic hemiplegia is a form of cerebral palsy characterized by unilateral paralysis affecting one side of the body, typically resulting from an injury to the brain during fetal development, birth, or shortly after. This condition manifests as increased muscle tone (spasticity) in the affected limbs, leading to difficulties in movement and coordination. Patients may exhibit weakness, stiffness, and reduced range of motion on the affected side, which can significantly impact their mobility and daily activities. Spastic hemiplegia can also be associated with other neurological deficits, including cognitive impairments and sensory processing issues. The severity of symptoms can vary widely among individuals, with some achieving a degree of independence while others may require extensive support. Early intervention through physical therapy, occupational therapy, and speech therapy is crucial for improving functional outcomes and enhancing quality of life. Understanding the complexities of spastic hemiplegia is essential for accurate coding and appropriate management of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity among patients
  • Need for comprehensive documentation of neurological assessments
  • Differentiation from other types of paralysis and cerebral palsy
  • Potential co-morbid conditions that may complicate coding

Audit Risk Factors

  • Inadequate documentation of neurological assessments
  • Failure to specify the affected side of the body
  • Misclassification with other types of cerebral palsy
  • Lack of evidence for co-morbid conditions

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological evaluations, including motor function assessments and spasticity measurements.

Common Clinical Scenarios

Patients presenting with unilateral weakness, spasticity, and developmental delays.

Billing Considerations

Ensure comprehensive documentation of neurological findings and treatment plans.

Physical Therapy

Documentation Requirements

Therapy progress notes, functional assessments, and treatment goals.

Common Clinical Scenarios

Patients undergoing rehabilitation for mobility impairments due to spastic hemiplegia.

Billing Considerations

Document specific interventions and patient responses to therapy.

Coding Guidelines

Inclusion Criteria

Use G81.1 When
  • According to ICD
  • 10 guidelines, G81
  • 1 should be used when there is clear documentation of spastic hemiplegia affecting one side of the body
  • It is important to specify the side affected (right or left) and to document any associated conditions or complications

Exclusion Criteria

Do NOT use G81.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97110CPT Code

Therapeutic exercises

Clinical Scenario

Used for patients with spastic hemiplegia to improve strength and mobility.

Documentation Requirements

Document specific exercises performed and patient progress.

Specialty Considerations

Physical therapy documentation should reflect the patient's functional goals.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like spastic hemiplegia, improving the accuracy of diagnoses and treatment plans. This specificity aids in better resource allocation and management of care for affected individuals.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like spastic hemiplegia, improving the accuracy of diagnoses and treatment plans. This specificity aids in better resource allocation and management of care for affected individuals.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like spastic hemiplegia, improving the accuracy of diagnoses and treatment plans. This specificity aids in better resource allocation and management of care for affected individuals.

Resources

Clinical References

  • •
    Cerebral Palsy Foundation

Coding & Billing References

  • •
    Cerebral Palsy Foundation

Frequently Asked Questions

What is the difference between spastic hemiplegia and other types of cerebral palsy?

Spastic hemiplegia specifically affects one side of the body, while other types of cerebral palsy may involve bilateral involvement or different patterns of muscle tone and movement.