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

This code signifies a persistent inflammatory arthritis affecting the left hand, specifically caused by the body's inability to properly excrete uric acid due to kidney dysfunction. The absence of tophi indicates that there are no visible or palpable uric acid crystal deposits under the skin or in joints.

Apply this code when documentation clearly states chronic gout in the left hand, directly attributed to renal impairment, and explicitly notes the absence of tophaceous deposits. This is appropriate for patients with a confirmed diagnosis of gout secondary to kidney disease, presenting with symptoms in the left hand.

• Ensure documentation specifies "chronic" gout and a direct link to "renal impairment" as the etiology.
• Verify the affected body part is the "left hand" and that "without tophus" is clearly stated.
• Always code the underlying renal impairment first, as it is the causal condition for this type of gout.