M10.19

Lead-induced gout affecting multiple joint sites simultaneously, classified under secondary gout caused by toxic lead exposure.

Verified May 8, 2026 · 4 sources ↓

Status: Billable
Chapter: 13
Related CPT: 5
Region: Multi-region

Drawn from CDCICDicd10data.com —AAPC

Documentation tips

What should appear in the chart to support M10.19.

Source · Editorial brief grounded in 4 cited references ↓

Provider must explicitly document lead as the causative agent — 'gout secondary to lead toxicity' or equivalent language is required to support M10.19 over idiopathic gout codes.
Record every affected joint by name and side; 'multiple sites' requires at least two distinct anatomical locations documented in the same encounter note.
Always assign a companion T56.0- code (toxic effects of lead and its compounds) with the appropriate 7th character (A, D, or S) per Tabular List instruction.
Document the source or route of lead exposure (occupational, environmental, retained projectile, etc.) to support medical necessity and toxicology workup coding.
Capture serum uric acid level, blood lead level result, and any joint aspiration findings (urate crystals) to substantiate both the gout diagnosis and the lead-toxic etiology.
If the patient has chronic lead nephropathy contributing to impaired urate excretion, document that relationship — it supports the lead-induced mechanism and may warrant an additional renal code.

Related CPT procedures

Procedure codes commonly billed with M10.19. Linking the right diagnosis to the right procedure is what establishes medical necessity.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

20610 $68.81

Aspiration and/or injection of a major joint or bursa (shoulder, hip, knee, or subacromial bursa) performed without ultrasound guidance.

20600 $56.11

Needle aspiration and/or injection of a small joint or bursa — such as a finger or toe joint — performed without ultrasound guidance.

20605 $57.12

Aspiration and/or injection of an intermediate joint or bursa — such as the wrist, elbow, ankle, acromioclavicular joint, or olecranon bursa — performed without ultrasound guidance.

83655 View procedure details

85025 View procedure details

Common coding pitfalls

The recurring mistakes coders make with M10.19 and adjacent codes.

Source · Editorial brief grounded in CDC ICD-10-CM tabular guidance, AAOS coding references, and cited references ↓

Omitting the required T56.0- companion code — the Tabular List 'Code Also' instruction makes it mandatory, and claims submitted without it are incomplete.
Using M10.19 when only one joint is involved — multiple sites means polyarticular; single-site lead-induced gout requires a laterality-specific M10.1x code.
Defaulting to M10.9 (gout, unspecified) or M10.0x (idiopathic gout) when lead etiology is documented — if the provider attributes gout to lead toxicity, the secondary gout code must reflect that specificity.
Assigning M10.19 without querying the provider when the note says 'gout' in a patient with known lead exposure but does not explicitly link the two — don't assume causation; query first.
Confusing M10.19 (lead-induced gout, multiple sites) with M1A.19 (chronic lead-induced gout, multiple sites) — use M10.19 for acute flares; M1A.19 when the provider documents chronic tophaceous gout due to lead.

Clinical context

Source · Editorial summary grounded in 4 cited references ↓

M10.19 applies when a patient presents with gout that is directly attributable to lead toxicity and the gouty involvement spans multiple anatomical sites — for example, simultaneous involvement of the first MTP joint, knee, and ankle. This is a secondary gout subtype under M10.1 (lead-induced gout); use it only when the provider has documented both the lead etiology and polyarticular distribution.

Critically, the ICD-10-CM Tabular List instructs coders to also assign a code from T56.0- (toxic effects of lead and its compounds) to identify the lead exposure. That companion code is mandatory, not optional — omitting it creates an incomplete code set and may trigger a payer query or denial. The T56.0- code carries 7th-character extensions: A (initial encounter), D (subsequent encounter), S (sequela).

If the gouty flare involves only one joint or one anatomical region, use the site-specific M10.1x code instead (e.g., M10.161 for the right knee). Reserve M10.19 strictly for confirmed polyarticular presentations. If the provider documents lead exposure and gout but does not specify the number of sites affected, query before defaulting to M10.10 (unspecified site).

Sibling codes

Other billable codes under M10.1 (laterality / anatomic variants).

M10.18

Lead-induced gout, vertebrae

M10.10

Lead-induced gout, unspecified site

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Do I have to assign a second code alongside M10.19?

Yes. The ICD-10-CM Tabular List includes a 'Code Also' instruction at the M10.1 category level requiring a T56.0- code (toxic effects of lead and its compounds). Assign T56.0x with the appropriate 7th character — A for initial encounter, D for subsequent, S for sequela. Omitting it leaves the code set incomplete.

02What distinguishes M10.19 from M1A.19?

M10.19 is used for acute lead-induced gout flares at multiple sites. M1A.19 is reserved for chronic lead-induced gout at multiple sites, which typically involves tophi. Use the provider's language — 'acute flare' versus 'chronic gouty arthropathy' or 'tophi' — to select the correct parent category.

03Can I use M10.19 if the provider documents gout and the patient has a history of lead exposure but doesn't explicitly link them?

No. You cannot infer causation. If the provider note does not explicitly state that the gout is caused by or due to lead toxicity, query the provider before assigning M10.19. Default to idiopathic gout codes (M10.0x) or M10.9 until the etiology is confirmed.

04What counts as 'multiple sites' for M10.19?

Two or more distinct anatomical joint sites must be documented as involved in the same encounter. For example, right first MTP joint plus left knee qualifies. A single joint with bilateral involvement does not automatically qualify; check whether a bilateral or site-specific code is more appropriate.

05Which CPT procedures are commonly billed with M10.19?

Joint aspiration and injection codes — 20610 (major joint), 20605 (intermediate joint), 20600 (small joint) — are frequently paired when synovial fluid is aspirated for crystal analysis. A blood lead level test (CPT 83655) or CBC (85025) may appear on the same encounter when workup is being performed or monitored.

06Is M10.19 valid for FY2026 claims?

Yes. M10.19 is a billable, specific code in the FY2026 ICD-10-CM code set, effective October 1, 2025. It has been a valid billable code continuously since FY2016 and has not been revised or retired in the current cycle.

07Should M10.19 be the principal or secondary diagnosis?

In most orthopedic encounters, M10.19 will be the principal diagnosis when the reason for the visit is management of the gouty arthritis. The T56.0- toxic-effects code is sequenced as an additional code per the 'Code Also' instruction, not as the principal diagnosis.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CDC ICD-10-CM Tabular List 2026 (effective October 1, 2025)
02ICD-10-CM Official Guidelines for Coding and Reporting FY2026 — http://stacks.cdc.gov/view/cdc/250974
03icd10data.com — https://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14/M10-/M10.19
04AAPC Codify — https://www.aapc.com/codes/icd-10-codes/M10.19

Mira AI Scribe

The Mira AI Scribe captures the provider's explicit attribution of gout to lead toxicity, the list of all affected joints with laterality, serum uric acid and blood lead level results, and any crystal analysis from joint aspiration. This prevents claim submission with an incomplete code set (missing T56.0-), avoids downgrade to unspecified gout M10.9, and flags when only a single site is documented so the coder selects the correct site-specific M10.1x code instead.

See how Mira captures M10.19 documentation