Podiatry Coding & Billing Alert

Remember: Read “code first” notes carefully.

If you report gout in your podiatry practice, you will need to understand many facets of this diagnosis, including the difference between acute and chronic gout, what the specific characters in the codes stand for, and how to code primary and secondary gout.

Read on to learn more.

Step 1: Figure Out What Gout Is

Gout belongs to a class of diseases known as crystal-induced arthropathies. An arthropathy is a disease of a joint in the body, and this particular group of arthropathies is distinguished by inflammation in the joint, or the tissues around the joint, caused by a buildup of crystal deposits in the joint itself.

Step 2: See Differences Between Acute, Chronic Gout

Gout can be either acute or chronic. For acute grout, you should look to category M10- (Gout). For chronic gout, you should look to category M1A- (Chronic gout).

Acute gout defined: Acute gout is a form of arthritis that creates pain, redness, and swelling, according to Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. A blood test will show increases uric acid, and the first metatarsophalangeal joint (MPJ) is the most common area for acute gout.

Chronic gout: With chronic gout, patients will have two or more flare ups in a year with multiple joint involvement, Beresh says. The patient will have symptoms, except for a short break in between the attacks. Chronic gout can lead to permanent joint stiffness, damage, and deformity.

Step 3: Use Seventh Character With Category M1A-

When you report a code from category M1A-, you will notice that these codes have a seventh character. That seventh character will be either a “0” or “1,” which identifies the absence of presence of tophi, respectively.

For example, your podiatrist documents that the patient has idiopathic chronic gout in her right ankle and foot, without tophi. You should report M1A.0710 (Idiopathic chronic gout, right ankle and foot, without tophus (tophi)) for this condition.

Don’t miss: Tophi are large, visible bumps composed of urate crystals.

Step 4: Opt for Primary, Secondary Gout Codes Carefully

Both the M1A.- and M10.- code sets make a distinction between primary or secondary gout. The codes are then broken down by etiology using the following fourth characters:

• MXX.0 — Idiopathic gout (The gout has occurred spontaneously, and the cause is unknown.)
• MXX.1 — Lead-induced gout
• MXX.2 — Drug-induced gout
• MXX.3 — Gout due to renal impairment
• MXX.4 — Other secondary gout
• MXX.9 — Unspecified

Secondary gout defined: Secondary gout is caused by a medication or another medical condition. When your podiatrist assigns a secondary gout code group, like renal failure with MXX.3, you must follow the “code first” notes associated with that code group. For example, in the case of lead-induced gout, that note reads, “code first toxic effects of lead and its compounds (T56.0-).” For other secondary gout causes besides lead, drugs, and renal impairment, you should look at MXX.4 and follow the instructions to code the associated condition first.

Step 5: Break Down Gout Fifth Character

The fifth character in a gout ICD-10-CM code pinpoints the exact anatomic location. For the ankle and foot, you will see “7” as this fifth character.

For example, for drug-induced gout of the right ankle and foot, you should report M10.271 (Drug-induced gout, right ankle and foot).

To report gout due to renal impairment of the left ankle and foot, you should report M10.372 (Gout due to renal impairment, left ankle and foot).

Step 6: Decipher Sixth Character of Gout Code

The sixth character of a gout ICD-10-CM code identifies the side of the body where the disease has been found. Expansion 1 is for the right side, 2 for the left, and 9 for the unspecified side of the body.

If M10.27- is for drug-induced gout, then you will see M10.271 (… right ankle and foot), M10.272 (…left ankle and foot), and M10.279 (… unspecified ankle and foot) as the final subcategories.