Chronic gout due to renal impairment, r shoulder, w/o toph

This code signifies a chronic inflammatory arthritis affecting the right shoulder, specifically caused by the accumulation of uric acid crystals due to impaired kidney function. It indicates that the characteristic nodular deposits of urate crystals (tophi) are not present in the affected joint.

Apply this code when documentation clearly states chronic gout in the right shoulder, explicitly links it to renal impairment as the underlying cause, and confirms the absence of tophi. This diagnosis is typically made based on clinical presentation, laboratory findings (elevated serum uric acid, renal function tests), and imaging, with the absence of palpable tophi.

• Ensure documentation specifies "chronic" gout and explicitly links it to "renal impairment."
• Verify the laterality (right shoulder) and the absence of tophi.
• Always code the underlying renal impairment first, as it is the etiology of the gout.