Chronic gout due to renal impairment, left wrist, w/o tophus

This code signifies a diagnosis of chronic gout that has developed as a direct consequence of impaired kidney function, specifically affecting the left wrist. It indicates the absence of tophi, which are deposits of uric acid crystals, in the affected joint. This condition results from the kidneys' inability to adequately excrete uric acid, leading to its accumulation and crystallization in the joints.

Use this code when documentation clearly states chronic gout in the left wrist is secondary to renal impairment, and no tophi are present. This typically applies to patients with pre-existing chronic kidney disease or other renal dysfunction who subsequently develop gout. Supporting documentation would include physician notes detailing the causal link between renal impairment and gout, joint examination findings, and imaging reports confirming gouty arthritis without tophaceous deposits.

• Always code the underlying renal impairment first, as it is the etiology of the gout.
• Ensure documentation explicitly states "chronic" gout and specifies the "left wrist" and "without tophus."
• Differentiate from other forms of secondary gout (e.g., drug-induced) or primary gout, which have different ICD-10-CM codes.