Podiatry Coding & Billing Alert

You will have to report additional codes to justify the cause of gout and its bilaterality.

Come October 2015, you will be better armed to report gout disease, when you can start reporting a slew of new and more accurate ICD-10 diagnosis codes. Keep this primer handy to help you with the changeover so that you hit the ground running and get the most out of your gout reporting.

Prepare to Work Harder to Pinpoint Gout Dx

Post 2010, you have been using an expanded set of ICD-9 codes to distinguish between the different conditions (acute or chronic) or presence/ absence of tophi. You can find the ICD-9 diagnosis codes for gout in Chapter 3 (Endocrine, Nutritional, and Metabolic diseases, and Immunity Disorders). 

Currently you report the gout diagnosis code according to the particular stage of the disease. As the gout progresses from acute to chronic, you report 274.01 (Acute gouty arthropathy) for newly diagnosed patients with acute symptoms of gout, code 274.02 (Chronic gouty arthropathy without mention of tophus [tophi]) for patients with a history of recurrent attacks of acute gout without tophi,and you code 274.03 (Chronic gouty arthropathy with tophus [tophi]) for unspecified site but with presence of tophi. Of course, you also have an all-purpose code 274.00 (Gouty arthropathy, unspecified) for unspecified gouty arthropathy.

Under ICD-10-CM, prepare to delve deeper into the physician’s notes after the transition as gout is not a diagnosis that will easily crosswalk from ICD-9 to ICD-10-CM. As with all other codes for bilateral organs, here too you will have specific codes for pointing out the left or right part of the body that is affected. Coding gout in ICD-10-CM will also require documentation to identify “with” or “without tophus.” You will have to visit Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue) for gout codes. 

Codes 274.00 and 274.01 both get listed as M10.00 (Idiopathic gout, unspecified site) in ICD-10-CM. Code 274.02 crosswalks to M1A.9XX0 (Chronic gout, unspecified, without tophus [tophi]). However, 274.03 can get translated to any one of four possibilities: M1A.00X1 (Idiopathic chronic gout, unspecified site, with tophus [tophi]), M1A.20X1 (Drug-induced chronic gout, unspecified site, with tophus [tophi]), M1A.30X1 (Chronic gout due to renal impairment, unspecified site, with tophus [tophi]), M1A.40X1 (Other secondary chronic gout, unspecified site, with tophus [tophi]), or M1A.9XX1 (Chronic gout, unspecified, with tophus [tophi]).

What’s new:

Wherever applicable within M10 (Gout), the fourth digit expansion specifies the cause of the gout, as following: 

• 0 -- Idiopathic gout 
  
• 1 -- Lead-induced gout 
  
• 2 -- Drug-induced gout
  
• 3 -- Gout due to renal impairment 
  
• 4 -- Other secondary gout
  
• 9 -- unspecified
  

Further, a fifth digit expansion (0-9) informs the location of the gout on the body. For example, M10.1- signifies (Lead-induced gout) and the fifth digit “7” points to ankle and foot (M10.17,Lead-induced gout, ankle and foot). 

To make the diagnosis even more precise, there may be a sixth digit expansion. The expansion will pinpoint the side of the body where the disease has been found. Therefore, expansion 1 is for the right side, 2 for the left, and 9 for the unspecified side of the body. Carrying forward the previous example, ifM10.17 is for lead-induced gout of ankle and foot, then you can expect to find M10.171 (…right ankle and foot), M10.172 (…left ankle and foot), and M10.179 (Lead-induced gout, unspecified ankle and foot) as the final subcategories.

Coding scenario: A new patient presents to your physician with severe pain and tenderness in the ankle joint and swelling of the affected joint. The skin over the joint is tight and is looking shiny and red.

As gout can be difficult to diagnose because of the symptoms mimicking those of other conditions such as joint infection, the physician orders gold standard tests such as aspiration and microscopic analysis for urate crystals in joint fluid or a tophus. Urate crystals are negatively birefringent under polarized light. He rules out infection.Presence of uric acid crystals confirms gout in the right ankle joint. The physician also confirms the presence of tophi. He documents the gout to be of idiopathic origin. In ICD-9, you would have coded this as 274.00 (Gouty arthropathy, unspecified) or 274.01 (Acute gouty arthropathy). However, you will able to present a very specific diagnosisunder ICD-10-CM, as you will code the disease as M10.071 (Idiopathic gout, right ankle and foot).

The physician may advise treatment to end the pain of acute flares, and to prevent future attacks and the formation of tophi and kidney stones. Therapy for acute flares consists of nonsteroidal anti-inflammatory drugs, steroids, and colchicine. Preventive therapy to lower blood uric acid levels in persons with recurrent acute flares or chronic gout usually involves allopurinol or a new drug (febuxostat).

Note: Under ICD-10, information about the underlying cause and anatomic location are important to your coding. “For any of the ICD-10 codes for chronic gout with tophi, the presence of tophi would need to be supported by documentation, and the causative factor and location of gout would determine code selection,” say experts.