Not Valid for Submission
M1A is a "header" nonspecific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of chronic gout. The code is NOT valid for the year 2021 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.
Specific Coding for Chronic gout
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code M1A:
Use Additional CodeUse Additional Code
The “use additional code” indicates that a secondary code could be used to further specify the patient’s condition. This note is not mandatory and is only used if enough information is available to assign an additional code.
- code to identify:
- Autonomic neuropathy in diseases classified elsewhere G99.0
- Calculus of urinary tract in diseases classified elsewhere N22
- Cardiomyopathy in diseases classified elsewhere I43
- Disorders of external ear in diseases classified elsewhere H61.1 H62.8
- Disorders of iris and ciliary body in diseases classified elsewhere H22
- Glomerular disorders in diseases classified elsewhere N08
Type 1 ExcludesType 1 Excludes
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- gout NOS M10
Type 2 ExcludesType 2 Excludes
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- acute gout M10
7th Character Note7th Character Note
Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- The appropriate 7th character is to be added to each code from category M1A
7th Character7th Character
Indicates that a seventh character is to be assigned to codes in a subcategory.
- 0 - without tophus (tophi)
- 1 - with tophus (tophi)
Information for Patients
Also called: Gouty arthritis
Gout is a common, painful form of arthritis. It causes swollen, red, hot and stiff joints.
Gout happens when uric acid builds up in your body. Uric acid comes from the breakdown of substances called purines. Purines are in your body's tissues and in foods, such as liver, dried beans and peas, and anchovies. Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But sometimes uric acid can build up and form needle-like crystals. When they form in your joints, it is very painful. The crystals can also cause kidney stones.
Often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers, and elbows. At first, gout attacks usually get better in days. Eventually, attacks last longer and happen more often.
You are more likely to get gout if you
- Are a man
- Have family member with gout
- Are overweight
- Drink alcohol
- Eat too many foods rich in purines
Gout can be hard to diagnose. Your doctor may take a sample of fluid from an inflamed joint to look for crystals. You can treat gout with medicines.
Pseudogout has similar symptoms and is sometimes confused with gout. However, it is caused by calcium phosphate, not uric acid.
NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Calcium pyrophosphate arthritis (Medical Encyclopedia)
- Gout (Medical Encyclopedia)
- Uric acid - blood (Medical Encyclopedia)
- Uric acid - urine (Medical Encyclopedia)