Don't miss what these seventh characters mean. A diagnosis of gout might seem simple enough to code, but a quick look at your ICD-9 choices shows more than 10 viable options. Ask your physician to provide details to help you pinpoint the correct code -- and to help prepare for ICD-10, when you'll have even more choices to consider. Is It Joint Pain, Arthritis, or Gout? Part of accurate coding includes understanding the conditions you're reporting. Gout is a form of arthritis of the joint that occurs due to high levels of uric acid in the blood. Elevated uric acid levels associated with gout attacks causes uric acid crystals to deposit in the synovial fluid of the joints and other soft tissues. Joints are a primary target site for uric acid crystal deposition. When crystals form in the synovial fluid, it causes recurring attacks of joint inflammation, or arthritis. Chronic gout can lead to deposits of hard lumps of uric acid in the tissues, called a tophus or tophi, in and around the joints that can lead to joint destruction. Diagnoses: Watch for Tophi and a Different Diagnosis Some patients who have longstanding gout diagnoses might develop tophi. A tophus (the singular form of tophi) is a mass of uric acid crystals that often appear around joints. Less common locations for tophi can include the patient's cartilage, bone, synovium, skin, kidneys, or other organs. The deposits often signify chronic gout since they usually take about 10 years to develop after the onset of gout. "Tophi are more common in men than women, but the incidence in women increases after they reach menopause," says Ruby O'Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, a compliance and research specialist with Twin Cities Orthopedics, P.A. Choices: Look Ahead to ICD-10 Options When ICD-10 goes into effect, your diagnosis options for gout greatly expand. Example: Fifth and sixth characters can further specify location of the chronic gout. For example, M1A.011 indicates "Idiopathic chronic gout, right shoulder." To indicate with tophus (or tophi), simply append the seventh character of "1." A seventh character of "0" indicates "without tophus (tophi)." These seventh characters may be added to any code from category M1A. Thus, unspecified chronic gout with tophus (tophi) would be coded as M1A.9xx1. Take note: