Chronic gout due to renal impairment, left shoulder, w toph

This code describes a chronic inflammatory arthritis affecting the left shoulder, specifically caused by elevated uric acid levels due to impaired kidney function. The presence of tophi, which are deposits of uric acid crystals, further characterizes this condition.

Use this code when documentation clearly indicates chronic gout in the left shoulder, directly attributed to renal impairment, and explicitly mentions the presence of tophaceous deposits. This typically occurs in patients with long-standing kidney disease and poorly controlled hyperuricemia.

• Ensure documentation specifies "chronic" gout and a causal link to "renal impairment."
• Verify the laterality (left shoulder) and the presence of "tophus" or "tophi."
• Code an additional diagnosis for the underlying renal impairment.