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ICD-10 Coding for Gout in the Left Great Toe(M10.072, M1A.0721)

Complete ICD-10-CM coding and documentation guide for Gout in the Left Great Toe. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

PodagraGouty Arthritis of the Toe

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Related ICD-10 Code Ranges

Complete code families applicable to Gout in the Left Great Toe

M10-M1APrimary Range

Gout

This range includes all codes related to gout, including acute and chronic forms, with specific codes for different causes and affected sites.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M10.072Idiopathic gout, left ankle and footUse for acute idiopathic gout flares in the left great toe without tophi.
  • Sudden onset of severe pain in the left great toe
  • Erythema and swelling
  • Synovial fluid analysis showing monosodium urate crystals
M1A.0721Chronic gout due to renal impairment, left ankle and foot, with tophus (tophi)Use for chronic gout with tophi in the left great toe.
  • Presence of tophi
  • Chronic symptoms lasting more than 3 months
  • Imaging evidence of urate deposits

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for gout left great toe

Essential facts and insights about Gout in the Left Great Toe

The ICD-10 code for acute idiopathic gout in the left great toe is M10.072, while chronic gout with tophi is coded as M1A.0721.

Primary ICD-10-CM Codes for gout left great toe

M10.072
Idiopathic gout, left ankle and foot
Billable Code

Decision Criteria

clinical Criteria

  • Presence of acute inflammation and pain in the left great toe

Applicable To

  • Acute idiopathic gout flare affecting the left great toe

Excludes

Clinical Validation Requirements

  • Sudden onset of severe pain in the left great toe
  • Erythema and swelling
  • Synovial fluid analysis showing monosodium urate crystals

Code-Specific Risks

  • Incorrectly using for chronic conditions with tophi

Coding Notes

  • Ensure documentation specifies acute flare and absence of tophi.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Long-term (current) use of other medications

Z79.899
Use when documenting long-term urate-lowering therapy.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Gout, unspecified

M10.9
Use when the specific site or type of gout is not documented.

Gout due to renal impairment

M10.37
Use when gout is specifically due to renal impairment.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Gout in the Left Great Toe to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M10.072.

Impact

Clinical: Lack of specificity can lead to inappropriate treatment., Regulatory: May result in coding audits., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Ensure documentation specifies laterality and acuity., Review coding guidelines regularly.

Impact

Reimbursement: Incorrect coding may lead to denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Use only the chronic code with a 7th character for flare if both conditions are present.

Impact

Using both acute and chronic codes for the same encounter.

Mitigation Strategy

Educate providers on proper code selection and documentation.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Gout in the Left Great Toe, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Gout in the Left Great Toe

Use these documentation templates to ensure complete and accurate documentation for Gout in the Left Great Toe. These templates include all required elements for proper coding and billing.

Acute gout flare in the left great toe

Specialty: Podiatry

Required Elements

  • Pain severity and location
  • Swelling and erythema
  • Synovial fluid analysis results

Example Documentation

Acute gout flare: Left great toe MTP joint with severe tenderness (8/10 pain), erythema, warmth, and inability to bear weight. Uric acid 9.2 mg/dL. No tophi observed.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has gout in the toe.
Good Documentation Example
Acute idiopathic gout flare affecting the left great toe with swelling, erythema, and severe tenderness. Synovial fluid analysis positive for MSU crystals.
Explanation
The good example provides specific details about the location, severity, and diagnostic confirmation, supporting accurate coding.

Need help with ICD-10 coding for Gout in the Left Great Toe? Ask your questions below.

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