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M1A ICD-10-CM Code: Chronic gout

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

7th character
Required — characters 0 · 1
Tabular directives
1 Excludes1 · 1 Excludes2 · 7 use-additional codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M1A in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on M1A itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify:
  • Autonomic neuropathy in diseases classified elsewhere (G99.0)
  • Calculus of urinary tract in diseases classified elsewhere (N22)
  • Cardiomyopathy in diseases classified elsewhere (I43)
  • Disorders of external ear in diseases classified elsewhere (H61.1-, H62.8-)
  • Disorders of iris and ciliary body in diseases classified elsewhere (H22)
  • Glomerular disorders in diseases classified elsewhere (N08)

7th Character Guide

"The appropriate 7th character is to be added to each code from category M1A"

  • 0 — without tophus (tophi)
  • 1 — with tophus (tophi)

Variant codes in this family

M1A.00X0, M1A.00X1, M1A.0110, M1A.0111, M1A.0120, M1A.0121, M1A.0190, M1A.0191

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for M1A

MedCoder structured workflow — derived from this code’s own official record

Before you code M1A

  1. M1A is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewM1A.0, M1A.1, M1A.2, M1A.3, M1A.4

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. A 7th character is required in this family. Confirm the documentation supports the character assigned — its meaning in this family is defined in the official instruction. M1A is not valid without one. The official 7th-character definitions for this family are quoted in the guide.

    See the 7th Character Guide

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with M1A. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support one of the more specific codes beneath M1A?
    Yes → Select that code and continue the checks below on its own page.
    No → M1A cannot be reported as written; query for the specificity its subcategory needs.

    ReviewM1A.0, M1A.1, M1A.2, M1A.3, M1A.4

  2. Does the documentation support a condition named in M1A’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewM10

  3. Does the documentation support one of this family’s 7th-character values?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider M1A. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
7th-character basis
The documented element this family’s 7th character records (see the official definitions in the 7th Character Guide).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting M1A(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with M1A: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareM10

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of M1A(1 note)

    Coding workflow: The conditions named in this note are not included in M1A. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareM10

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying M1A(7 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with M1A when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewG99.0, N22, I43, H61.1, H62.8, H22

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition M1A describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewM10

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with M1A?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewG99.0, N22, I43, H61.1, H62.8, H22

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Chronic gout is a non-billable ICD-10-CM category code (M1A). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. 7 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  4. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name M1A or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes: E72 — Other disorders of amino-acid metabolism, E79 — Disorders of purine and pyrimidine metabolism.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Excludes2 notes across 2 chapters: H61.1 — Noninfective disorders of pinna, M10 — Gout.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 5 Code First instructions across 4 chapters: G99.0 — Autonomic neuropathy in diseases classified elsewhere, H22 — Disorders of iris and ciliary body in diseases classified elsewhere, H62.8 — Other disorders of external ear in diseases classified elsewhere, N08 — Glomerular disorders in diseases classified elsewhere, N22 — Calculus of urinary tract in diseases classified elsewhere.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Contextual Map

Every relationship of M1A in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run M1A with these 10 related codes in Claim Check

Hierarchy

Excludes1

  • M10 — Gout[Excludes1]: “gout NOS (M10.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Excludes2

  • M10 — Gout[Excludes2]: “acute gout (M10.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Use Additional Code

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code First instructions

Nearest codes (400)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Can M1A be billed directly?

No. M1A (Chronic gout) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does M1A require a 7th character?

Yes. The appropriate 7th character is to be added to each code from category M1A; 0: without tophus (tophi); 1: with tophus (tophi).

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Chronic gout

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M1A in its code family, with their registry titles.