Podiatry Coding & Billing Alert

Hint: The fifth character in a gout Dx code tells you the exact anatomic location.

Since ICD-10-CM offers so many diagnosis codes to choose from, it can be difficult to know which ones you should report on specific claims. For example, an overweight patient with hypertension visits your podiatrist complaining of severe pain, swelling, and heat in the joint of the big toe on her left foot. The patient confirms that she drinks excessive amounts of alcohol and consumes a diet rich in meat and high-fructose foods. Your podiatrist may arrive at a diagnosis of gout after reviewing the patient’s X-rays, but if you don’t read the medical documentation for details like whether the gout is primary or secondary, you could be putting your claims in serious jeopardy.

Read on to keep your gout claims in tip-top shape.

First, Define Gout for Clarity

Question 1: What is gout?

Answer 1: 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.

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, Minnesota.

“Gout is due to monosodium urate crystal deposition, while pseudogout is caused by calcium pyrophosphate crystals, a different crystalline deposition,” O’Brochta- Woodward continues. “Pseudogout should be coded to M11.2- [Other chondrocalcinosis] group, where you would look to the anatomical location of the [resident’s] condition for specificity.”

As for gouty arthropathy or gouty arthritis, “if the provider stated either of these in the dictation report, you would need more information to code them to a further degree of specificity. Otherwise you will use the unspecified code M10.9 [Gout, unspecified] instead,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

Distinguish Between Acute and Chronic Gout

Question 2: Are there different code sets for acute versus chronic grout?

Answer 2: Yes. For chronic gout, you’ll use the M1A- (Chronic gout) group. For acute grout, you should look to the M10- (Gout) group.

Avoid 7th character confusion: Aside from documenting the different manifestations of the condition, the other major difference between the M1A- and M10- code groups is that only category M1A- takes an additional seventh character, either 0 or 1, to mark the absence or presence of tophi, respectively.

Coding 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)).

On the other hand, to report drug-induced chronic gout of the left ankle and foot without tophi, you would report M1A.2720 (Drug-induced chronic gout, left ankle and foot, without tophus (tophi)).

Choose Between These Codes for Primary and Secondary Gout

Question 3: Are there any differences between the codes for primary or secondary gout?

Answer 3: Yes. Both the M1A.- and M10.- code sets make a distinction between primary or secondary gout, which is gout caused by a medication or another medical condition. The codes are then broken down by etiology using the following fourth characters:

• MXX.0 — Idiopathic gout (meaning that 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

When your provider assigns a secondary gout code group, such as renal failure with MXX.3, make sure you obey the code first notes associated with the code groups. In the case of renal failure, for example, that note reads “code first associated renal disease.” For other secondary gout causes besides lead, drugs, and renal impairment, you will go to MXX.4 and follow the instructions to code the associated condition first.

Coding example: For a patient that has chronic gout without tophi in the right ankle and foot due to arthropathic psoriasis, you would code L40.5- (Arthropathic psoriasis) first, followed by M1A.4710 (Other secondary chronic gout, right ankle and foot, without tophus (tophi)).

Identify Fifth Character in Gout Codes

Question 4: What does the fifth character tell me in a gout ICD-10-CM code?

Answer 4: The fifth character in a gout code pinpoints the exact anatomic location. For the ankle and foot, you will see “7” as this fifth character.

For example, to report idiopathic chronic gout of the right ankle and foot, without tophus, you would report M1A.0710 (Idiopathic chronic gout, right ankle and foot, without tophus (tophi)).

To report lead-induced gout of the left ankle and foot, you would report M10.172 (Lead-induced gout, left ankle and foot).

Clarify Importance of Sixth Character

Question 5: What will the sixth character of a gout code tell me?

Answer 5: The sixth character identifies 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.

Coding example: If M10.17- 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.