ICD 10 Coding Alert

Question: My coworker and I are trying to determine the reason for a claim denial we received recently. The practitioner diagnosed the patient with pseudogout, and I coded the condition using the code we always use for gout. Is there a difference between gout and pseudogout?

Arizona Subscriber

Answer: Yes, there is a difference between gout and pseudogout.

Gout is caused by deposits of monosodium urate crystals in the joint. Report idiopathic chronic gout (chronic gout that has no known cause) with a code from the M1A.0- (Idiopathic chronic gout) series.

Pseudogout is caused by calcium pyrophosphate crystal deposits in the joint instead, and you would report this with a code from the M11.2- (Other chondrocalcinosis) group. This condition is commonly referred to as chondrocalcinosis.

Make note: Once you know the type of gout the patient has, you’ll code based on the location of the chondrocalcinosis to the 6^th character, which may help you avoid denials in the future.

Here are a few examples:

• M11.231 (Other chondrocalcinosis, right wrist)
• M11.241 (Other chondrocalcinosis, right hand)
• M11.262 (Other chondrocalcinosis, left knee).

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC