ICD-10 Coding for History of Gout(Z86.71, M1A.XXXX)
Complete ICD-10-CM coding and documentation guide for History of Gout. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Gout
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z86.71 | Personal history of gout | Use when the patient had gout in the past but it is resolved. |
|
| M1A.XXXX | Chronic gout | Use when gout is chronic, even if in remission. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for history of gout
Essential facts and insights about History of Gout
Primary ICD-10-CM Codes for history of gout
Decision Criteria
clinical Criteria
- Patient has no symptoms and normal urate levels.
coding Criteria
- Gout is resolved and not under treatment.
Clinical Validation Requirements
- No recurrent flares
- Not on urate-lowering therapy
- Normal serum urate levels
Code-Specific Risks
- Incorrectly using for chronic gout cases
Coding Notes
- Ensure documentation clearly states the condition is resolved.
M1A.XXXX - Chronic gout
Use when gout is chronic, even if in remission.
Applicable To
- Chronic gout with or without tophi
Excludes
- Acute gout (M10.-)
Clinical Validation Requirements
- Serum urate >6.8 mg/dL
- Imaging evidence of urate deposition
Coding Notes
Document laterality and tophi status.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of anticoagulants
Z79.01Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Gout to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z86.71.
Impact
Clinical: Misrepresentation of patient's current health status., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Verify current treatment and symptoms., Use correct ICD-10 codes for chronic conditions.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use M1A.XXXX + Z79.01 instead
Impact
Using Z86.71 for active chronic gout cases.
Mitigation Strategy
Regular training on ICD-10 coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Gout, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Gout
Use these documentation templates to ensure complete and accurate documentation for History of Gout. These templates include all required elements for proper coding and billing.
Chronic gout monitoring
Specialty: RheumatologyRequired Elements
- Affected joints
- Tophi status
- Current serum urate
- ULT adherence
- Functional impact
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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