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Home Health ICD-9/ICD-10 Alert

CODING HOW-TOGather Details For Gouty Arthropathy

Published on Thu Jan 22, 2009

Know the difference between acute and chronic to choose the right code.

If you're still listing 274.0 (Gouty arthropathy) for gouty arthropathy, you're risking denials. Make sure you're up to date with the latest ICD-9 developments for this diagnosis.

Get Specific with Gouty Arthropathy

Gout is caused by excessive production of uric acid or a decreased capacity of the kidney to get rid of uric acid. Effective Oct. 1, 2009, 274.0x codes began requiring a fifth digit, and 274.0 became an unacceptable diagnosis code, says Jun Mapili, PT, MAEd, with Global Home Care in Troy, Mich. Prior to that date, 274.0 offered no detail to distinguish between the different conditions (acute or chronic), or presence/absence of tophi. Recognizing the need for this, new codes were added for 2010.

ICD-9 2010 now requires a fifth digit for 274.0 as follows:

• 274.00 -- Gouty arthropathy, unspecified

• 274.01 -- Acute gouty arthropathy

• 274.02 -- Chronic gouty arthropathy without mention of tophus [tophi]

• 274.03 -- Chronic gouty arthropathy with tophus [tophi].

The new codes make properly coding the correct stage of this condition easier. ICD-9 2010 includes codes for each particular stage of the disease.

Coding example: Your new patient is recovering from toe amputation due to gangrene caused by chronic gouty arthropathy. Physical therapy will provide the most visits and will be focused on transferring, training, bed mobility, and caregiver training -- this is the focus of care. The patient also has unstable hypertension (HTN) and nursing will be assessing the effectiveness of the patient's hypertension medication.

He also has a history of CVA with muscle weakness, and difficulty in walking.

Code for this patient as follows:

• M1020a: V54.89 (Other orthopedic aftercare), M01024a column 3: 274.02 (Chronic gouty arthropathy without mention of tophus [tophi]), M01024a column 4: 785.4 (Gangrene);

• M1022b: 274.02 (Chronic gouty arthropathy without mention of tophus [tophi]);

• M1022c: 401.9 (Essential hypertension; unspecified);

• M1022d: 438.89 (Other late effects of cerebrovascular disease); and

• M1022e: 728.87 (Muscle weakness [generalized]).

In this scenario, your focus of care is aftercare for the patient's amputation surgery, so V58.49 is your principal diagnosis.

Place the codes for gouty arthropathy and its manifestation gangrene in M01024 for added case mix points.

Next step: Report gouty arthropathy in M1022 because the patient still has this condition following the surgery. Then list a code for the patient's hypertension.

Since the patient's muscle weakness is a late effect of an old CVA, you'll list 438.89 before you code the muscle weakness.

Details Indicate Acute or Chronic

Patients with acute gouty arthropathy experience an intense, sudden appearance of gout signs and symptoms or a rapidly worsening disease, says Mapili. On the other hand, those with chronic gouty arthropathy have a continuous persistence of signs and symptoms over an extended period of time, typically long-lasting and not easily or immediately resolved. Chronic gouty arthropathy involves recurrent episodes of joint soreness.

Look for clues in the documentation, especially the physician's referral, such as "acute gout," "gout attack," "gout flare," or "podagra" since these terms signify an acute gouty arthropathy that should be coded with 274.01, Mapili says.

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