2025 ICD-10-CM code M1A.9
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Musculoskeletal disorders - Other arthropathies Chapter XIII: Diseases of the musculoskeletal system and connective tissue Feed
Chronic gout, unspecified; repeated joint pain and inflammation due to uric acid crystal deposits.
Modifiers may be applicable depending on the circumstances of the encounter.Consult the appropriate payer's guidelines for specific modifier rules.
Medical necessity for the diagnosis and treatment of chronic gout is established by the presence of clinical symptoms and laboratory evidence of hyperuricemia.The frequency and severity of gout attacks, the presence of complications such as tophi or joint damage, and the patient’s response to treatment all contribute to determining the medical necessity of ongoing management.
Diagnosis and management of chronic gout involves obtaining a complete patient history, performing a physical examination, ordering and interpreting laboratory and imaging tests, and formulating a treatment plan that may include medication, dietary changes, and lifestyle modifications.The provider should also educate the patient on the disease process and its management.
- Chapter XIII: Diseases of the musculoskeletal system and connective tissue
- M00-M25 Arthropathies; M05-M14 Inflammatory polyarthropathies
In simple words: Chronic gout is a type of arthritis that causes repeated episodes of pain and swelling in the joints.It's caused by too much uric acid in the body, which forms crystals that deposit in the joints. Doctors diagnose it through exams and blood tests, and treatment includes medication to reduce pain and inflammation, along with changes in diet and lifestyle.
Chronic gout, unspecified, is characterized by recurrent episodes of pain and inflammation in one or more joints. This condition results from the deposition of monosodium urate crystals in the joints, a consequence of hyperuricemia (elevated uric acid levels in the blood).The specific type of gout is not specified in this code.Diagnosis is established through patient history, physical examination, imaging studies (e.g., X-rays), and laboratory tests (serum uric acid levels, urinalysis, synovial fluid analysis, and potentially synovial biopsy). Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, colchicine, xanthine oxidase inhibitors, and supportive measures such as dietary modifications and increased fluid intake.
Example 1: A 60-year-old male presents with recurrent attacks of severe pain and swelling in his right great toe, accompanied by redness and warmth.Laboratory tests reveal elevated serum uric acid levels, and X-rays show joint damage.The diagnosis is chronic gout, unspecified (M1A.9)., A 55-year-old female with a history of hypertension and hyperlipidemia reports multiple episodes of joint pain and swelling affecting various joints.She has tophi on her elbows.Blood tests confirm hyperuricemia, leading to a diagnosis of chronic gout, unspecified (M1A.9), with tophi (M1A.91)., A 70-year-old male with a history of chronic gout experiences a flare-up of symptoms.He presents with pain and stiffness in his knees and hands.His physician prescribes allopurinol to manage his hyperuricemia and NSAIDs to control the acute inflammation. The diagnosis is chronic gout, unspecified (M1A.9).
Detailed patient history including duration and frequency of gout attacks, affected joints, presence of tophi, previous treatments, family history of gout, and relevant comorbidities.Results of laboratory tests (serum uric acid, urinalysis, synovial fluid analysis if performed), and imaging studies (X-rays, ultrasound, or other relevant imaging).Documentation of the treatment plan and patient education regarding gout management.
** The unspecified nature of this code implies that the provider has not further specified the type of chronic gout.Always ensure complete and accurate documentation to support the selection of this code.
- Payment Status: Active
- Specialties:Rheumatology, Internal Medicine, Family Medicine
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Urgent Care Facility