M1A: Chronic gout
M1A is a non-billable header ICD-10-CM code for chronic gout. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.
This code requires a 7th character
The appropriate 7th character is to be added to each code from category M1A
- 0
- without tophus (tophi)
- 1
- with tophus (tophi)
Excludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- gout NOS (M10.-)
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- acute gout (M10.-)
Use additional code
Add a secondary code to capture the detail described below.
- code to identify:
- Autonomic neuropathy in diseases classified elsewhere (G99.0)
- Calculus of urinary tract in diseases classified elsewhere (N22)
- Cardiomyopathy in diseases classified elsewhere (I43)
- Disorders of external ear in diseases classified elsewhere (H61.1-, H62.8-)
- Disorders of iris and ciliary body in diseases classified elsewhere (H22)
- Glomerular disorders in diseases classified elsewhere (N08)
Other codes that can never be billed with M1A
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Code history
Unchanged in every release from FY2024 to FY2027.
Code to one of these instead M1A
6 child codes. Green means billable.