11/16/2022

Correct Billing for Idiopathic Gout

why do we keep getting denied for diagnosis M10.07 - is there another code we should be using for gout?

The diagnosis code is being denied because it is not being submitted with the highest level of specificity. Idiopathic gout requires a sixth character in order for it to be a billable condition linked to a CPT code:

• M10.071: Idiopathic gout, right ankle and foot
• M10.072: Idiopathic gout, left ankle and foot

Any denied claims should be resubmitted with one of the two codes listed above.