2026 ICD-10-CM Diagnosis Code R53.2Functional quadriplegia
ICD-10-CM Codes›R00–R99›R50-R69›R53
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 180
- Chronic Condition
R53.2 is a billable ICD-10-CM diagnosis code for functional quadriplegia. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 947 through 948. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 136 closely related codes. As a symptom code, it should not be used as a principal diagnosis once a related definitive diagnosis has been established. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Nervous system signs and symptoms.
For Medicare Advantage risk adjustment, R53.2 maps to CMS-HCC Category 180 (Quadriplegia) under the V28 model, adding a risk factor of about 1.125 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
R53.2 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Functional quadriplegia
- Functional quadriplegia due to multiple sclerosis
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Complete immobility due to severe physical disability or frailty
Type 1 Excludes
- frailty NOS R54
- hysterical paralysis F44.4
- immobility syndrome M62.3
- neurologic quadriplegia G82.5
- quadriplegia G82.50
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
functional R53.2
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Paralysis
Paralysis is the loss of muscle function in part of your body. It happens when something goes wrong with the way messages pass between your brain and muscles. Paralysis can be complete or partial. It can occur on one or both sides of your body. It can also occur in just one area, or it can be widespread.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert R53.2 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About R53.2Overview
What is the ICD-10 code for functional quadriplegia?
The ICD-10-CM code for functional quadriplegia is R53.2 (sometimes written as R532). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is R53.2 (Malaise and fatigue) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report functional quadriplegia on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does R53.2 group to?
When functional quadriplegia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 947, 948, with relative weights from 0.8005 to 1.2694 depending on complications. Higher weights mean higher Medicare reimbursement.
Is R53.2 a CC or MCC?
CMS lists R53.2 as an MCC (major complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 136 closely related codes in its exclusion list.
Can R53.2 be a principal diagnosis?
Use it with care. This is a symptom code, so once a definitive diagnosis explaining the functional quadriplegia is established, that condition takes the principal position instead.
What HCC is R53.2?
R53.2 (functional quadriplegia) maps to CMS-HCC Category 180 (Quadriplegia), commonly written as HCC 180, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 70 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does R53.2 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, R53.2 adds a risk adjustment factor of about 1.125 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.735 to 1.399 depending on the payment segment). A more severe related category (HCC 191 and HCC 192) supersedes it when both are reported. See the full factor table on the HCC 180 category page.
