December 7, 2009

Coding for Gout
For The Record
Vol. 21 No. 23 P. 28

Gout is a type of arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in joints. Although it usually affects the large joint in the big toe, it can also occur in the feet, ankles, knees, hands, and wrists. The affected joint becomes hot, swollen, and extremely tender. Gout results from urate crystals accumulating around the joint. Urate crystals form due to high levels of uric acid in the blood (hyperuricemia).

Gout is classified to ICD-9-CM category 274. Gouty arthropathy or gout arthritis is classified to subcategory 274.0. The fifth-digit subclassification identifies whether the gouty arthropathy is acute (274.01), chronic (274.02), chronic with tophus (274.03), or unspecified (274.00). Acute gouty arthropathy includes gout attack and gout flare.

Gouty nephropathy is classified to subcategory 274.1 and includes unspecified (274.10), uric acid nephrolithiasis (274.11), or other specified gouty nephropathy (274.19).

Gout with other specified manifestations is assigned to subcategory 274.8 and includes gouty tophi of ear (274.81) and gouty tophi of other sites (274.82). If a patient had other specified manifestations of gout of other sites, code 274.89 would be assigned along with another code to identify the manifestation, such as gouty iritis (364.11), gouty neuritis (357.4), gouty episcleritis (379.09), and gouty phlebitis (451.9).

Other types of specified gout may go to a code outside of category 274. Two examples include rheumatic gout (714.0) and syphilitic gout (095.8).

Unspecified gout is classified to code 274.9.

Symptoms
Common signs and symptoms of gout include the following:

• intense joint pain that is most severe for the first 12 to 24 hours following the onset and may be described as sudden burning pain;

• lingering discomfort that may last for a few days to a few weeks (Subsequent attacks may last longer and affect more joints.);

• inflammation, swelling, tenderness, and redness of the affected joint;
• stiffness; and

• fever.

Untreated gout may lead to more pain and joint damage.

Diagnosis
To confirm a gout diagnosis, a physician may perform the following tests:

• a joint fluid test, which involves extracting some fluid from the affected joint to determine whether urate crystals are present; or

• a blood test, which identifies the presence of uric acid.

Treatment
Gout is most commonly treated with medications that will address acute attacks and prevent future attacks. The following are some common medications used to treat gout:

• Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, and indomethacin control inflammation and pain.

• Colchicines reduce gout pain.

• Corticosteroids such as prednisone control gout inflammation and pain.

• Xanthine oxidase inhibitors limit the amount of uric acid made in the body. Common examples include allopurinol and febuxostat.

• Probenecid improves uric acid removal.

Coding and sequencing for gout are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.