ICD 10 code for gout
ICD 10 code for gout is a billing code used by physical therapists for a certain form of arthritis that is a common cause of pain and functional impairments. Physical therapy is an excellent treatment option for individuals with arthritis. Gout is a complex form of arthritis characterized by sudden, severe bouts of joint swelling, pain, warmth, redness, and tenderness.
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Gout attacks are most common in the joint at the base of the big toe but can occur in any joint. Ankles, knees, fingers, wrists and elbows may be affected by gout as well. An attack of gout typically occurs suddenly. Many gout sufferers report waking in the middle of the night with pain, heat, and redness in a joint so severe that even the bedsheet touching the area is unbearable.
An accumulation of needle-like urate crystals in the joint causes the inflammation and pain characteristic of gout. These urate crystals form in response to an imbalance in either the production or excretion of uric acid.
Several factors can increase the likelihood of developing gout:
- Male sex
- Post-menopausal status in women
- Medications including low dose aspirin, ACE inhibitors and anti-rejection medications for post-organ transplant patients
- A personal history of uncontrolled high blood pressure, diabetes, metabolic syndrome, or heart and kidney disease
- A family history of gout
Joint erosion causing prolonged pain and functional impairments can develop if gout is not treated. Medication management is often a first line treatment for gout but physical therapists also play a role in the management of this condition. Physical therapists can work to restore joint range of motion, manage joint pain and inflammation, educate patients on the use of splints or assistive devices to improve comfort, assist with lifestyle modifications that can reduce the risk for recurrent gout and apply interventions that can improve their patients’ function.
Just like when treating any condition, it is important you bill accurately for the treatment of gout in order to receive timely and accurate payment. One step in this process is selecting and submitting the correct ICD 10 diagnosis codes. If you, like many therapists, have some experience searching for and selecting ICD-10 codes but don’t have a great understanding of the who, what, when and why these codes are used, see the next section for an ICD-10 code primer. Following this introduction we will discuss the ICD10 code for gout in more detail.
An introduction to ICD-10 Codes
Who: All HIPAA-covered entities are required to submit ICD-10 codes if seeking reimbursement for services from an insurance company. This includes physical therapists.
What: The International Classification of Disease, 10th Revision (ICD-10) is a set of diagnosis, symptom, and procedure codes that physical therapists use daily in their practice. In 2015 physical therapists and all other HIPAA-covered healthcare providers transitioned from the ICD-9 to the current version, ICD-10. ICD-10 codes are alphanumeric codes. They begin with a letter and are always between three and seven characters with a decimal point placed after the third character.
The more characters it has, the more specific it is. Each code follows the following structure:
- Characters 1-3 indicate the category of the diagnosis
- Characters 4-6 indicate etiology, anatomic site, severity or other clinical detail
- Character 7 is an extension value, for example:
- A: Initial encounter (anything related to care of the initial injury)
- D: Subsequent encounter (anything related to the phase of routine care of the injury while the patient recovers–this usually refers to rehabilitation)
- S: Sequela (other conditions that may result from the presence of the primary condition)
Note, for fracture care, there are several more extensions ( example: P, G, K, which signify malunion, delayed healing, or nonunion for a subsequent encounter)
When: ICD-10 codes must be submitted with relevant documentation whenever reimbursement is sought for covered services either by the healthcare entity itself or by a patient.
Why: While it may seem like an extra step in an already detailed process of documentation and billing, ICD-10 codes are required for a specific reason. Not only do they identify a medical diagnosis, but perhaps more importantly, they help insurance companies understand why the care you are providing is medically necessary and therefore, reimbursable.
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Acute and chronic ICD code for gout
When selecting an ICD 10 code for gout, the code with the highest number of applicable characters should be chosen, at least on the first visit. Greater specificity is more likely to lead to reimbursement but it should always be supported by the patient’s medical record and clinical knowledge of the patient’s condition.
Many three and even sometimes four digit codes can be found for a given condition when searching a reputable database like ICD10 Data, but if a more detailed code is available, this code may not be reimbursable by insurance.
What is the ICD-10 code for acute gout?
M10: Acute Gout is the ICD 10 code for gout is used when the patient is presenting with an acute gout attack or gout flare.
What is the ICD-10 code for chronic gout?
M1A: Chronic Gout is the ICD 10 code for gout is used when the patient is presenting with chronic gout.
Are these ICD 10 codes for gout billable?
Each ICD 10 code for gout in their three digit format is considered too nonspecific for billing/reimbursement purposes, but there are codes with more digits that are more specific and therefore reimbursable. When you search the code M10 or M1A you will see a long list of more specific codes that are divided into affected body parts as well as laterality, when indicated.
These codes can be found for the following areas:
- Shoulder
- Elbow
- Wrist
- Hand
- Hip
- Knee
- Ankle and foot
- Vertebrae
- Multiple sites
You can also use an ICD 10 code for gout that specifies both location and cause of gout if you happen to know the cause.
These include gout induced by:
- Lead
- Drugs
- Renal impairments
- Other
- Idiopathic
ICD 10 code for gout tips
In addition to documenting the ICD 10 code for gout as the medical condition, you want to ensure you are documenting the functional limitations caused by this condition. Be sure to assess, measure and document functional impairments that impact your patient’s ADLs, mobility and ability to perform job, caretaking or recreational activities as this is the information insurance companies want to see when they review your documentation.
A few examples of codes that may also be relevant to the care of patients with gout include:
- Z74.09: Impaired mobility
- R26.89: Painful gait/other abnormalities of gait and mobility
- R26.2: Difficulty walking
Code changes
The Centers for Medicare and Medicaid Services publish an updated list of codes each year to go into effect October 1 and remain in effect until September 30 of the following year. Sites like ICD10 Data can also be helpful in identifying code changes once they update their list as announced on their homepage.
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How EHR and practice management software can save physical therapists time with insurance billing
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant physical therapists advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save physical therapists time when it comes to insurance billing for therapists.
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including physical therapists in group and solo practices.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
- Practice management tools
