Gout: Diagnosing and Treating

by  Find-A-Code™
Jan 1st, 2019 - Reviewed/Updated Apr 23rd

Patients suffering from gout (M10.-) will often have symptoms affecting the joints due to accumulated uric acid crystals and fluid in the joint space which causes pain, inflammation, and stiffness. When the underlying cause of gout is unknown, it is referred to as idiopathic gout

Testing to diagnose gout may include:

• Removal and testing of accumulated fluid in a symptomatic joint.
• Blood tests to measure serum creatinine (an elevated level means the kidneys aren’t functioning well) which may increase (even temporarily) when a patient is dehydrated, takes certain medications, or has consumed a lot of meat recently.
• Imaging of the joints using plain radiographs, ultrasound, or computed tomography (CT) scans to identify the presence of uric crystals within the affected joint(s).

Gout Treatment Options:

• Diet restrictions to reduce uric acid buildup (e.g., alcohol, red meat, sugar) as well as exercise and weight loss
• Over-the-counter (OTC) medications (nonsteroidal anti-inflammatories [NSAIDs]) like Advil, Motrin (ibuprofen), or naproxen sodium (Aleve)
• Prescription medications including higher dosage NSAIDs like indomethacin (Indocin) or celecoxib (Celebrex), anti-gout medications like Colcrys or Mitigare (colchicine), or an oral corticosteroid like prednisone Aspiration to remove the excess fluid from the affected joint and an injection of a corticosteroid directly into the joint to reduce inflammation
• Arthrocentesis (aspiration/injection) is commonly performed when treating gout. The following coding table can help with code selection:

Arthrocentesis Coding Example

Example: Following sterile prep using Betadine, 10 cc of serosanguinous fluid was aspirated from the right knee immediately followed by an injection of 4 mg of dexamethasone with 3 ml of 1% lidocaine into the medial aspect of the right flexed knee. There were no complications. The patient tolerated the procedure well. The same procedure was performed on the left knee. The payer prefers to have the RT and LT on separate lines.

Report as;

20610- RT
20610- LT
J1100 (8 units)

Arthrocentesis Coding Tips

• HCPCS codes are used to report drugs used for therapeutic purposes such as the corticosteroid injection dexamethasone. In the above example, report J1100 for every 1 mg of dexamethasone injected into the joint space. Be sure to increase the number of units billed in Item Number 24G of the Claim Form to match the amount injected as noted in the documentation.
• Codes 20600-20611 include both aspiration and injection when performed during the same encounter and should NOT be unbundled for separate payment.
• The Medicare Physician Fee Schedule (MPFS) bilateral indicator for these injection codes is a 1, indicating that a 150% payment adjustment for bilateral procedures is applicable. Be sure to read all procedure documentation carefully to identify whether or not ultrasound was used for needle placement before making the final code selection.