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ICD-10 Guide
DiagnosesArthritis Gout

Arthritis Gout

ICD-10 Coding for Arthritis Gout(M10.072, M1A.0720)

PRIMARY SPECIALTYEmergency Medicine
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Arthritis Gout?
Essential facts and insights about Arthritis Gout

Key Clinical Considerations:

  • Presence of acute or chronic joint pain, often in the big toe (podagra) or other joints.
  • Elevated serum uric acid levels (hyperuricemia) confirmed through laboratory testing.
  • Physical examination revealing swollen, red, and tender joints.
  • Imaging studies (e.g., X-rays, ultrasound) may show joint effusion or tophi in chronic cases.
  • Severity can be assessed based on frequency of attacks and joint involvement.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Complete medical history including onset, duration, and characteristics of symptoms.
  • Specific terminology such as 'gouty arthritis' or 'acute gout flare' must be documented.
  • Examples include noting the presence of tophi or joint effusion in the medical record.
  • Documentation must support medical necessity for treatment and diagnostic tests.
  • Quality measures may include tracking frequency of gout attacks and serum uric acid levels.

Coding Guidelines

Usage Guidelines & Examples

  • Use M10.072 for acute gouty arthritis of the left ankle and foot; M1A.0720 for chronic gout.
  • Do not use these codes for other types of arthritis such as osteoarthritis or rheumatoid arthritis.
  • M10.071 (acute gouty arthritis of the right ankle and foot) is a related code for the opposite side.
  • Common errors include misclassifying gout as another type of arthritis; ensure accurate symptom documentation.
  • In complex cases, consider the patient's history of gout attacks and any comorbid conditions.

Code Exclusions

Important Exclusions

  • Excludes conditions such as osteoarthritis and rheumatoid arthritis.
  • Alternative codes for excluded conditions include M15 (Polyosteoarthritis) for osteoarthritis.
  • Conditions are excluded due to differing pathophysiology and treatment approaches.
  • Common mistakes include coding gout when the patient has another type of arthritis; verify clinical findings.
  • Related but distinct conditions include calcium pyrophosphate dihydrate crystal deposition disease (pseudogout).

Related ICD-10 Codes

Primary Codes
M10.072
Acute gouty arthritis of the left ankle and foot
M1A.0720
Chronic gout due to renal impairment, left ankle and foot
Ancillary Codes
Z68.3
Z87.310
Differential Codes
M1A.0720
M10.072

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Emergency Medicine

Specialty Applications

  • Patients with a history of hyperuricemia or previous gout attacks.
  • More prevalent in males, particularly those over 40 years of age.
  • Clinical settings include emergency departments for acute flares and outpatient clinics for management.
  • Specialty-specific applications in rheumatology and primary care.
  • Treatment contexts include acute management with NSAIDs or corticosteroids and long-term urate-lowering therapy.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with gout based on clinical findings of joint pain and elevated uric acid levels.'

Template 2

Template: 'Clinical presentation consistent with acute gout including swelling and tenderness in the left big toe.'

Template 3

Template: 'Diagnostic criteria for gout met as evidenced by serum uric acid level of 8.5 mg/dL.'

Template 4

Template: 'Treatment plan initiated for gout with NSAIDs and patient education on dietary modifications.'

Template 5

Template: 'Follow-up care for gout including monitoring serum uric acid levels every 3 months.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Document clinical findings, lab results, and treatment plans clearly.

How does this differ from similar diagnoses?

Gout is characterized by hyperuricemia and acute attacks, unlike other arthritides.

What are common billing considerations?

Ensure documentation supports the medical necessity of treatments and tests.

What procedures are typically associated?

CPT codes for joint aspiration or injection may be relevant.

Are there any quality reporting implications?

Monitor serum uric acid levels and frequency of attacks for quality measures.