Did you know heavy metal toxicity can trigger a severe form of inflammatory arthritis? Code M1A.159 identifies lead-induced chronic gout affecting an unspecified hip. While rare today, Saturnine gout has a rich medical history linked to occupational exposure and contaminated moonshine. Coders must pay close attention to etiology and anatomical specificity when managing these complex cases. Correct secondary coding for heavy metal toxicity is essential to paint the full clinical picture.