Primary Care Coding Alert

Thwart autorejections for 274.0 (Gouty arthropathy) come Oct. 1 by mapping key terms to this condition's new fifth digit.

As primary care physicians, family physicians often are the first ones to encounter presence of gout in patients. Be familiar with the new codes for 2010 to avoid denials and revenue loss.

Previously, gouty arthropathy was listed broadly as "Gouty Arthropathy." No attempt to distinguish between the different conditions (acute or chronic), or presence/ absence of tophi, was done for previous versions of ICD-9-CM. Recognizing the need for this, additional codes have been included.

Getting new diagnosis codes that provide additional specificity can certainly be a plus, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

ICD-9 2010 requires a fifth digit on 274.0 as follows:

To aid in understanding these new codes, here are some pointers:

• Gouty arthropathy: This disease affects middle-aged to elderly men and postmenopausal women and is associated with hyperuricemia (elevated uric acid levels). The disease is due to the deposition of urate crystals in the joints as well as other organs (for example, the kidneys).

• Acute gout: This is the initial early clinical manifestations of gouty arthropathy often described as severe joint pain and swelling.

• Chronic gout: This is the recurring form of gout involving one or several joints occasionally associated with the presence of tophaceous deposits.

• Tophus (tophi): These are deposits of urate crystals in the skin surrounding the joints. This can be seen as elevated lesions on the joint area.

Properly Code for the Gouty Arthropathy Stage

The new codes make properly coding the correct stage or this condition easier. ICD-9 2010 includes codes for the particular stage of the disease.

Gout progresses from acute to chronic. These scenarios will help guide your gouty code selection:

1. For newly diagnosed patients with acute symptoms of gout, report 274.01.

2. For patients with a history of recurrent attacks of acute gout without tophi, use 274.02.

3. If tophi are mentioned without specifying the site, assign 274.03.

4. Otherwise, if tophi were specified to the ear or other sites, such as the heart, then the old ICD-9 codes still apply: 274.81 (Gouty tophi of ear) and 274.82 (Gouty tophi of other sites) respectively.