Presented by Beth Sassano CPC,
CPC-I, CCS-P, CPMA
A condition marked by increased levels of uric acid in the blood, joints,
and tissue. The buildup of uric acid in the joints and tissues causes
arthritis and inflammation.
Gout is a common, painful form of arthritis. It causes swollen, red, hot
and stiff joints. It happens if your body produces extra acid or does not
eliminate enough, or if you eat too many foods with purines, such as
liver and dried beans.
Pseudogout has similar symptoms and is sometimes confused with gout.
However, it is caused by calcium phosphate, not uric acid. Often, gout
first attacks your big toe. It can also attack ankles, heels, knees, wrists,
fingers and elbows. You are more likely to get gout if you
◦ are a man
◦ have family member with gout
◦ drink alcohol
At first, gout attacks usually get better in days but
eventually, attacks can last longer and happen more
often.
Untreated gout can cause permanent joint and
kidney damage. You can treat gout with medicines.
(nih: national institute of arthritis and musculoskeletal and skin diseases)
Hereditary metabolic disorder characterized by
recurrent acute arthritis, hyperuricemia and
deposition of sodium urate in and around the
joints, sometimes with formation of uric acid
calculi.
Check if the pain is Joint Pain, is Arthritic or Gout?
Watch for Tophi:
Some patients who have a longstanding gout diagnosis may
develop tophi. “A tophus (the singular form of tophi) is a
mass of uric acid crystals that often appear around joints.
Less common locations for tophi can include the patient’s
cartilage, bone, synovium, skin, kidneys, or other organs. The
deposits often signify chronic gout since they usually take
about 10 years to develop after the onset of gout.”
“Tophi are more common in men than women, but the
incidence in women increases after they reach menopause,”
says Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC,
ACS-OR, a compliance and research specialist with Twin
Cities Orthopedics, P.A.
Coding gout in ICD-10-CM will require
documentation to identify “with” or “without
tophus”.
Not only will the requirement of coding “with” or
“without tophus” allow more code choices, so will
the expansion of codes sets in Chapter 13.
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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Applicable To Acute gout
Gout attack
Gout flare
Gout NOS
Type 1 Excludes chronic gout M1A.-
In ICD-10, chronic gout is classified to a series of codes beginning with
M1A. A fourth character further classifies the gout as follows:
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M1A.0 Idiopathic
M1A.1 Lead-induced
M1A.2 Drug-induced
M1A.3 Chronic gout due to renal impairment
M1A.4 Other secondary chronic gout
M1A.9 Chronic gout, unspecified
Fifth and sixth characters can further specify location of the chronic gout.
For example, M1A.011 indicates “Idiopathic chronic gout, right shoulder.”
To indicate with tophus (or tophi), simply append the seventh character of
“1.”
A seventh character of “0” indicates “without tophus (tophi).”
These seventh characters may be added to any code from category M1A.
Thus, unspecified chronic gout with tophus (tophi) would be coded as
M1A.9xx1.
Gout is not a diagnosis that will easily crosswalk from ICD-9
to ICD-10-CM, so documentation is key for correct code
assignment.
For example:
◦ Code 274.00 (Gouty arthropathy, unspecified) is listed as M10.00
(Idiopathic gout, unspecified site) in ICD-10-CM. This is only for
an unspecified site.
The provider must document the site that is affected by gout.
For example:
◦ M10.01 (idiopathic gout, shoulder) will need to be coded with one
of the following codes:
◦ M10.011 (idiopathic gout, right shoulder),
◦ M10.012 (idiopathic gout, left shoulder), or
◦ M10.019 (idiopathic gout, unspecified shoulder).
Use Additional code to identify:
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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)
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M10 Gout
M10.0 Idiopathic gout
M10.00 …… unspecified site
M10.01 Idiopathic gout, shoulder
M10.011 Idiopathic gout, right shoulder
M10.012 Idiopathic gout, left shoulder
M10.019 Idiopathic gout, unspecified shoulder
M10.02 Idiopathic gout, elbow
M10.021 Idiopathic gout, right elbow
M10.022 Idiopathic gout, left elbow
M10.029 Idiopathic gout, unspecified elbow
M10.03 Idiopathic gout, wrist
M10.031 Idiopathic gout, right wrist
M10.032 Idiopathic gout, left wrist
M10.039 Idiopathic gout, unspecified wrist
M10.04 Idiopathic gout, hand
M10.041 Idiopathic gout, right hand
M10.042 Idiopathic gout, left hand
M10.049 Idiopathic gout, unspecified hand
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M10.05 Idiopathic gout, hip
M10.051 Idiopathic gout, right hip
M10.052 Idiopathic gout, left hip
M10.059 Idiopathic gout, unspecified hip
M10.06 Idiopathic gout, knee
M10.061 Idiopathic gout, right knee
M10.062 Idiopathic gout, left knee
M10.069 Idiopathic gout, unspecified knee
M10.07 Idiopathic gout, ankle and foot
M10.071 Idiopathic gout, right ankle and foot
M10.072 Idiopathic gout, left ankle and foot
M10.079 Idiopathic gout, unspecified ankle and
foot
M10.08 …… vertebrae
M10.09 …… multiple sites
M10.1 Lead-induced gout
M10.10 …… unspecified site
M10.11 Lead-induced gout, shoulder
M10.111 Lead-induced gout, right shoulder
M10.112 Lead-induced gout, left shoulder
M10.119 Lead-induced gout, unspecified shoulder
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M10.12 Lead-induced gout, elbow
M10.121 Lead-induced gout, right elbow
M10.122 Lead-induced gout, left elbow
M10.129 Lead-induced gout, unspecified
M10.13 Lead-induced gout, wrist
M10.131 Lead-induced gout, right wrist
M10.132 Lead-induced gout, left wrist
M10.139 Lead-induced gout, unspecified
M10.14 Lead-induced gout, hand
M10.141 Lead-induced gout, right hand
M10.142 Lead-induced gout, left hand
M10.149 Lead-induced gout, unspecified
M10.15 Lead-induced gout, hip
M10.151 Lead-induced gout, right hip
M10.152 Lead-induced gout, left hip
M10.159 Lead-induced gout, unspecified
M10.16 Lead-induced gout, knee
M10.161 Lead-induced gout, right knee
M10.162 Lead-induced gout, left knee
M10.169 Lead-induced gout, unspecified
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elbow
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wrist
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hand
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hip
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knee
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M10.17 Lead-induced gout, ankle and foot
M10.171 Lead-induced gout, right ankle and foot
M10.172 Lead-induced gout, left ankle and foot
M10.179 Lead-induced gout, unspecified ankle and foot
M10.18 …… vertebrae
M10.19 …… multiple sites
M10.2 Drug-induced gout
M10.20 …… unspecified site
M10.21 Drug-induced gout, shoulder
M10.211 Drug-induced gout, right shoulder
M10.212 Drug-induced gout, left shoulder
M10.219 Drug-induced gout, unspecified shoulder
M10.22 Drug-induced gout, elbow
M10.221 Drug-induced gout, right elbow
M10.222 Drug-induced gout, left elbow
M10.229 Drug-induced gout, unspecified elbow
M10.23 Drug-induced gout, wrist
M10.231 Drug-induced gout, right wrist
M10.232 Drug-induced gout, left wrist
M10.239 Drug-induced gout, unspecified wrist
M10.24 Drug-induced gout, hand
M10.241 Drug-induced gout, right hand
M10.242 Drug-induced gout, left hand
M10.249 Drug-induced gout, unspecified hand
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M10.25 Drug-induced gout, hip
M10.251 Drug-induced gout, right hip
M10.252 Drug-induced gout, left hip
M10.259 Drug-induced gout, unspecified hip
M10.26 Drug-induced gout, knee
M10.261 Drug-induced gout, right knee
M10.262 Drug-induced gout, left knee
M10.269 Drug-induced gout, unspecified knee
M10.27 Drug-induced gout, ankle and foot
M10.271 Drug-induced gout, right ankle and foot
M10.272 Drug-induced gout, left ankle and foot
M10.279 Drug-induced gout, unspecified ankle and foot
M10.28 …… vertebrae
M10.29 …… multiple sites
M10.3 Gout due to renal impairment
M10.30 …… unspecified site
M10.31 Gout due to renal impairment, shoulder
M10.311 Gout due to renal impairment, right shoulder
M10.312 Gout due to renal impairment, left shoulder
M10.319 Gout due to renal impairment, unspecified shoulder
M10.32 Gout due to renal impairment, elbow
M10.321 Gout due to renal impairment, right elbow
M10.322 Gout due to renal impairment, left elbow
M10.329 Gout due to renal impairment, unspecified elbow
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M10.33 Gout due to renal impairment, wrist
M10.331 Gout due to renal impairment, right wrist
M10.332 Gout due to renal impairment, left wrist
M10.339 Gout due to renal impairment, unspecified wrist
M10.34 Gout due to renal impairment, hand
M10.341 Gout due to renal impairment, right hand
M10.342 Gout due to renal impairment, left hand
M10.349 Gout due to renal impairment, unspecified hand
M10.35 Gout due to renal impairment, hip
M10.351 Gout due to renal impairment, right hip
M10.352 Gout due to renal impairment, left hip
M10.359 Gout due to renal impairment, unspecified hip
M10.36 Gout due to renal impairment, knee
M10.361 Gout due to renal impairment, right knee
M10.362 Gout due to renal impairment, left knee
M10.369 Gout due to renal impairment, unspecified knee
M10.37 Gout due to renal impairment, ankle and foot
M10.371 Gout due to renal impairment, right ankle and foot
M10.372 Gout due to renal impairment, left ankle and foot
M10.379 Gout due to renal impairment, unspecified ankle and
foot
M10.38 …… vertebrae
M10.39 …… multiple sites
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M10.4 Other secondary gout
M10.40 …… unspecified site
M10.41 Other secondary gout, shoulder
M10.411 Other secondary gout, right shoulder
M10.412 Other secondary gout, left shoulder
M10.419 Other secondary gout, unspecified shoulder
M10.42 Other secondary gout, elbow
M10.421 Other secondary gout, right elbow
M10.422 Other secondary gout, left elbow
M10.429 Other secondary gout, unspecified elbow
M10.43 Other secondary gout, wrist
M10.431 Other secondary gout, right wrist
M10.432 Other secondary gout, left wrist
M10.439 Other secondary gout, unspecified wrist
M10.44 Other secondary gout, hand
M10.441 Other secondary gout, right hand
M10.442 Other secondary gout, left hand
M10.449 Other secondary gout, unspecified hand
M10.45 Other secondary gout, hip
M10.451 Other secondary gout, right hip
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M10.452 Other secondary gout, left hip
M10.459 Other secondary gout, unspecified hip
M10.46 Other secondary gout, knee
M10.461 Other secondary gout, right knee
M10.462 Other secondary gout, left knee
M10.469 Other secondary gout, unspecified knee
M10.47 Other secondary gout, ankle and foot
M10.471 Other secondary gout, right ankle and foot
M10.472 Other secondary gout, left ankle and foot
M10.479 Other secondary gout, unspecified ankle
M10.452 Other secondary gout, left hip
M10.459 Other secondary gout, unspecified hip
M10.46 Other secondary gout, knee
M10.461 Other secondary gout, right knee
M10.462 Other secondary gout, left knee
M10.469 Other secondary gout, unspecified knee
M10.47 Other secondary gout, ankle and foot
M10.471 Other secondary gout, right ankle and foot
M10.472 Other secondary gout, left ankle and foot
M10.479 Other secondary gout, unspecified ankle
M10.48 …… vertebrae
M10.49 …… multiple sites
M10.9 Gout, unspecified
Morbid obesity is a commonly used term used to
refer to patients whose body weight is between
50%-100% and 100 pounds or more than the
normal body weight. Obese patients are normally
identified with a body mass index of 39.
In 2009-2010, a report stated that the prevalence
of obesity among American men and women was
nearly 36 percent.
Additionally, approximately 17 percent (or 12.5
million) of children and adolescents aged 2-19
years are obese.
For correct coding of overweight and obesity,
documentation should include:
 Severity — Terms such as overweight, obese, or
morbid obesity;
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Contributing factors — Such as excessive
calories or “drug induced”;
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Association — Of any Pregnancy
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Symptoms/Findings/Manifestations —
Documentation of BMI or Alveolar hypoventilation
BMI is the measurement of body fat based on
height and weight. Obesity is diagnosed when
a person’s BMI is 30 or higher. Body mass
index is calculated by dividing weight in
kilograms (kg) by height in meters (m)
squared. Category
BMI
Underweight
Below 18.5
Normal
18.5-24.9
Overweight
25.0-29.9
Obesity
30.0 and above
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E66 Overweight and obesity
E66.0 Obesity due to excess calories
E66.01 Morbid (severe) obesity due to
excess calories
E66.09 Other obesity due to excess
calories
E66.1 Drug-induced obesity
E66.2 Morbid (severe) obesity with
alveolar hypoventilation
E66.3 Overweight
E66.8 Other obesity
E66.9 Obesity, unspecified
Overweight and obesity E66 Code First obesity complicating pregnancy,
childbirth and the puerperium, if applicable
(O99.21-)
 Use Additional code to identify body mass
index (BMI), if known (Z68.-)
◦ Type 1 Excludes:
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adiposogenital dystrophy (E23.6)
lipomatosis NOS (E88.2)
lipomatosis dolorosa [Dercum] (E88.2)
Prader-Willi syndrome (Q87.1)
Encounter for general adult medical examination without
abnormal findings:
Z00.00 is a billable ICD-10-CM code that can be used to
indicate a diagnosis for reimbursement purposes. Used for
encounters for adult health check-up NOS
Z00.01 - Encounter for general adult medical examination with
abnormal findings,
Z01.411 - Encounter for gynecological examination (general)
(routine) WITH abnormal findings,
Z01.419 - Encounter for gynecological examination (general)
(routine) WITHOUT abnormal findings.
When reporting a gynecological exam, you may
report additional codes:
◦ screening for human papillomavirus (Z11.51),
◦ screening vaginal Pap smear (Z12.72), or
◦ acquired absence of uterus (Z90.71), if applicable.
If you provide a screening pap smear for malignant
neoplasm of the cervix outside of a gynecological exam,
you would report that with code Z12.4.
It is not necessary to report code Z12.4 when the
screening takes place as part of a gynecological exam
(Z01.411 or Z01.419).
Codes for newborn health exams:
◦ Use Z00.110 for a newborn under 8 days old
◦ Z00.111 for a newborn 8 to 28 days old.
◦ For children 29 days old and older:
 Use one of two codes:
 Z00.121, Encounter for routine child health examination
WITH abnormal findings. Diagnosis codes for abnormal
findings should be coded regardless of whether the
finding requires an additionally reportable service.
or
 Z00.129, Encounter for routine child health examination
WITHOUT abnormal findings.
ICD-10 allows you to report code Z23 for a visit involving
immunization regardless of the type or number of vaccines.
With ICD-9, you have to report V04.81 for the influenza
vaccine alone or V06.6 if you provide both the influenza
vaccine and the pneumonia vaccine on the same date.
With ICD-10, you just code Z23 regardless of how many or
what types of vaccines are administered.
◦ The Z23 code includes the following note: “Code first any routine
childhood examination.”
◦ Therefore, when you provide immunizations with a well-child
visit, a code for routine child health examination should be
reported first, followed by Z23 for any immunizations. (similar to
ICD-9).
Your code selection for a routine examination
of the eyes and vision will also depend on
whether you have identified any abnormal
findings. The codes are as follows:
 Z01.00, Encounter for examination of eyes
and vision without abnormal findings,
 Z01.01, Encounter for examination of eyes
and vision with abnormal findings.
Code selection depends on whether there has
been any abnormal findings identified or
whether the patient has already failed a hearing
screening. Code options are as follows:
 Z01.10, Encounter for examination of ears
and hearing WITHOUT abnormal findings,
 Z01.110, Encounter for hearing examination
following FAILED hearing screening,
 Z01.118, Encounter for examination of ears
and hearing WITH other abnormal findings
Colorectal cancer screening:
V76.51 Screening malignant
neoplasm colon
Z12.11 Encounter for screening
for malignant neoplasm of colon
Diabetes screening
V77.1 Screening for diabetes
mellitus
Z13.1 Encounter for screening for
diabetes mellitus
Human immunodeficiency virus
screening
V73.89 Screening for other
specified viral diseases
Z11.4 Encounter for screening for
HIV
Osteoporosis screening
V82.81 Screening for osteoporosis
Prostate cancer screening
V76.44 Screening for malignancy
prostate
Sexually transmitted infection (STI)
screening and high intensity
behavioral counseling to prevent STIs
 V74.5 Screening for venereal
disease
 V69.8 Other problems related to
lifestyle
 V73.89 Screening for other
specified viral disease
 V73.88 Screening for other
specified chlamydial disease
Z13.820 Encounter for screening for
osteoporosis
Z12.5 Encounter for screening for
malignant neoplasm of prostate
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Z11.3 Encounter for screening for
infections with a predominantly
sexual mode of transmission
Z72.89 Other problems related to
lifestyle
Z11.59 Encounter for screening for
other viral diseases
Z11.8 Encounter for screening for
other infectious and parasitic
diseases (e.g., chlamydia)
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Obesity: ICD-10-CM Code Assignment: by
John Verhovshek, MA, CPC
Code It Right online May 23, 2013
Cindy Hughes, CPC, CFPC - FPM's ICD-10
coding series continues with a look at how to
code immunizations, routine health exams,
and common preventive screenings.
Fam Pract Manag. 2014 Jul-Aug;21(4):OA1OA4.
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