ICD-10 Coding for Gouty Arthritis(M10.0, M1A.0)
Complete ICD-10-CM coding and documentation guide for Gouty Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gouty Arthritis
M10-M1APrimary Range
Gout
This range includes all forms of gout, including idiopathic, lead-induced, drug-induced, and chronic gout with or without tophi.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M10.0 | Idiopathic gout | Use for acute idiopathic gout episodes. |
|
| M1A.0 | Chronic gout | Use for chronic gout conditions, especially with tophi. |
|
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 gouty arthritis
Essential facts and insights about Gouty Arthritis
Primary ICD-10-CM Codes for gouty arthritis
Decision Criteria
clinical Criteria
- Acute presentation with synovial fluid analysis confirming MSU crystals.
Applicable To
- Acute idiopathic gout
Excludes
- Chronic gout (M1A.-)
Clinical Validation Requirements
- Presence of monosodium urate (MSU) crystals in synovial fluid
- Serum urate level >6.8 mg/dL
Code-Specific Risks
- Risk of incorrect coding if chronic gout is present.
Coding Notes
- Ensure acute vs. chronic status is clearly documented.
M1A.0 - Chronic gout
Use for chronic gout conditions, especially with tophi.
Applicable To
- Chronic idiopathic gout
Excludes
- Acute gout (M10.-)
Clinical Validation Requirements
- Chronic symptoms with evidence of tophi or frequent flares
- Serum urate level >6.8 mg/dL
Coding Notes
Document presence of tophi and chronicity.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gouty Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M10.0.
Impact
Clinical: Leads to inadequate treatment plans., Regulatory: Non-compliance with coding guidelines., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Ensure complete documentation of site and etiology.
Impact
Reimbursement: May lead to claim denials., Compliance: Violates Excludes1 note., Data Quality: Compromises data accuracy.
Mitigation Strategy
Use only the acute code if an acute flare is present.
Impact
High risk of audit if unspecified codes are used when specific codes are available.
Mitigation Strategy
Always document and code the specific site and etiology.
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 Gouty Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gouty Arthritis
Use these documentation templates to ensure complete and accurate documentation for Gouty Arthritis. These templates include all required elements for proper coding and billing.
Acute gout flare in a patient with chronic gout
Specialty: RheumatologyRequired Elements
- History of present illness
- Physical examination findings
- Laboratory results
- Imaging studies
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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