ICD 10 Coding Alert

Tip: Look to Section M in your ICD-10-CM book.

Before you became a coder, you may have associated gout with historical fiction or period films. But gout can cause a lot of pain for modern patients, and the nuances can be a bit of a headache for modern coders, too.

Between primary, secondary, acute, and chronic, there are myriad presentations of gout. Grab your ICD-10-CM book and get cozy so you can approach future claims with confidence.

Explore Gout Categories

The first step in identifying the right gout code involves understanding the terminology that providers and ICD-10-CM use to describe the condition. Check out the key terms you’ll need to know as you navigate the diagnosis code options:

Gout: Caused by deposits of monosodium urate crystals in the joint. Report idiopathic chronic gout (chronic gout that has no known cause) with a code from the M1A.0- (Idiopathic chronic gout) series.

Pseudogout (also referred to as Chondrocalcinosis): Caused by calcium pyrophosphate crystal deposits in the joint, you would report this with a code from M11.2- (Other chondrocalcinosis) group.

Gouty arthropathy: Caused by urate crystal deposits in the joints and other organs. Without a more specific diagnosis, you might consider reporting M11.9 (Crystal arthropathy, unspecified) for this condition.

Coding caution: One problem facing coders involves providers using numerous terms that describe similar, yet slightly different, conditions. “It is very common for providers to state gouty arthropathy, gouty arthritis, or pseudogout,” says Ruby O’Brochta- Woodward, BSN, CPC, CPMA, CPB, COSC, CSFAC, coding and compliance manager at Suburban Imaging in Minneapolis.

If you can’t tell which of these definitions describe your patient’s condition after reviewing the documentation, you should query the podiatrist to find out which type of gout to start with. Once you’re aware of the gout type, you can move on to the next steps in coding the condition.

Distinguish Acute vs. Chronic Gout

Once you know the type of gout your patient has, you’ll need to identify whether it’s acute or chronic before you can pinpoint a specific ICD-10-CM code. To do this, you may need to consult the definitions of each, since the podiatrist may not use the terms “acute” and “chronic” in the documentation.

Acute gout: When the patient is showing the initial, early clinical manifestations of gout, characterized by severe joint pain and swelling, this may indicate acute gout, which you’ll code using the M10- (Gout) series.

Chronic gout: When the patient’s gout recurs and/or involves multiple joints, that may indicate chronic gout, which is coded from the M1A- (Chronic gout) range.

You also cannot look for guidance from professional organizations to determine whether a condition is acute or chronic, as they use different timeframes for chronic conditions. The National Cancer Institute, for example, defines a chronic disease as “a disease or condition that usually lasts for 3 months or longer” (Source: www.cancer.gov/publications/dictionaries/ cancer-terms/ def/chronic-disease), while the Centers for Disease Control and Prevention (CDC) defines chronic diseases “conditions that last 1 year or more” (Source: www.cdc.gov/chronicdisease/about/index.htm).

As there is such a huge discrepancy in the definitions used by professional institutions, it seems clear that you cannot use any one specific time period to determine when acute conditions end and chronic conditions begin.

This means the decision to define a condition as acute or chronic is up to your provider, and your coding needs to be dependent on their judgement. If you are habitually confused about whether to use an acute or chronic gout code, it may be a good idea to ask your podiatrist to denote acute and chronic in their documentation in the future.

Keep an Eye Out for ‘Tophi’

If your documentation review indicates that the patient has chronic gout, you’ll then need to investigate the medical record further to determine whether the patient has signs of tophi, which will help you determine the diagnosis code’s 7th character.

First, however, you’ll need to know what tophi (or tophus) refers to. Tophi “are deposits of urate crystals in the joints. The body can’t get rid of the amount of urates produced over time, which leads to crystal formation,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

As “there has not been enough time for this to happen in the acute state, tophi usually only appear with a patient with chronic gouty arthritis,” Witt notes. This is why you’ll only see “with tophi” added to code descriptors in the M1A- series.

For example: To document drug-induced chronic gout in the patient’s left ankle and foot with tophi, you would report M1A.2721 (Drug-induced chronic gout, left ankle and foot, with tophus (tophi)).

If, however, the patient had no tophi, you’d report M1A.2720 (Drug-induced chronic gout, left ankle and foot, without tophus (tophi)) instead for drug-induced chronic gout in the patient’s left ankle and foot.