Coding Gout Condition: Look for All Codes in ICD-9 and ICD-10

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ICD-10 will have many more options in 2013. A diagnosis of gout may appear simple enough to code, however a quick glance at your ICD-9 choices demonstrates more than 10 feasible options. Ask your physician to deliver details to help you identify the accurate code -- and to help prepare for ICD-10, when you'll have even more selections to consider. Part of precise medical coding includes understanding the conditions you're reporting. Gout is a form of arthritis of the joint that takes place because of high levels of uric acid in the blood. Raised uric acid levels related with gout attacks lead to uric acid crystals to deposit in the synovial fluid of the joints and other soft tissues. Joints are a main target site for uric acid crystal deposition. While crystals form in the synovial fluid, it causes frequent attacks of joint inflammation, or arthritis. Chronicgout can cause deposits of hard lumps of uric acid in the tissues, named a tophus or tophi, in and around the joints that can result in joint destruction. Diagnoses: Gout diagnoses come under code family 274.xx (Gout) in ICD-9. For a patient's first experience with gout, 274.01 (Acute gouty arthopathy) might be your best choice, lest the physician doesn't specify a kind of gout. In that case, you must report 274.9 (Gout, unspecified). Look Ahead to ICD-10 Options When ICD-9 to ICD-10 transition takes place in October 2013, your diagnosis options for gout significantly expand. Example: While ICD-9 has a single code for chronic gout with tophi, ICD-10 will let you indicate chronic gout with tophi by means of any one of more than 100 codes. Under ICD-10, chronic gout is categorized to a series of codes beginning with M1A. A fourth character further categorizes the gout as follows:
  • M1A.0 (Idiopathic)

  • M1A.1 (Lead-induced)

  • M1A.2 (Drug-induced)

  • M1A.3 (Chronic gout due to renal impairment)

  • M1A.40x1 (Other secondary chronic gout)

  • M1A.9 (Chronicgout, unspecified)

  • Fifth and sixth characters can additionally specify location of the chronic gout. For instance, M1A.011 specifies "Idiopathic chronicgout, right shoulder." To specify with tophus (or tophi), just append the seventh character of "1." A seventh character of "0" specifies "without tophus (tophi)." These seventh characters may be added to any code from category M1A. Consequently, unspecified chronic gout with tophus (tophi) would be coded as M1A.9xx1. ICD-9 to ICD-10 Transition Tip: 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.

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