M1A.0191 — Idiopathic chronic gout, unspecified shoulder, with tophus (tophi)
M1A.0191 is a billable, specific ICD-10-CM code for idiopathic chronic gout, unspecified shoulder, with tophus (tophi). It is valid for submission on a claim.
7th character "1" — with tophus (tophi)
The appropriate 7th character is to be added to each code from category M1A
- 0
- without tophus (tophi)
- 1
- with tophus (tophi)
Risk adjustment
M1A.0191 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
M1A.0191 is named in 6 Medicare coverage policies — 0 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Related codes at this level
Codes that share M1A.019. If M1A.0191 is not quite right, the correct code is usually one of these.
Questions about M1A.0191
- Is M1A.0191 a billable ICD-10-CM code?
- Yes. M1A.0191 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M1A.0191 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Inflammatory polyarthropathies (M05-M14).