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ICD-10 Coding for Abscessed Tooth(K04.7, K04.6)

Complete ICD-10-CM coding and documentation guide for Abscessed Tooth. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Dental AbscessPeriapical Abscess

Related ICD-10 Code Ranges

Complete code families applicable to Abscessed Tooth

K04.6-K04.7Primary Range

Diseases of pulp and periapical tissues

This range includes codes for periapical abscesses with and without sinus involvement.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
K04.7Periapical abscess without sinusUse when imaging confirms abscess confined to periapical region without sinus tract.
  • Radiographic evidence of periapical radiolucency
  • No sinus tract present
K04.6Periapical abscess with sinusUse when a sinus tract is present and documented.
  • Radiographic or clinical evidence of sinus tract

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for abscessed tooth

Essential facts and insights about Abscessed Tooth

The ICD-10 code for a periapical abscess without sinus is K04.7, while with sinus involvement it is K04.6.

Primary ICD-10-CM Codes for abscess tooth

Periapical abscess without sinus
Billable Code

Decision Criteria

clinical Criteria

  • Radiographic evidence of abscess without sinus tract

Applicable To

  • Periapical abscess confined to the tooth root area

Excludes

  • Periapical abscess with sinus (K04.6)

Clinical Validation Requirements

  • Radiographic evidence of periapical radiolucency
  • No sinus tract present

Code-Specific Risks

  • Incorrectly coding as K04.6 if sinus tract is not present.

Coding Notes

  • Ensure documentation specifies absence of sinus tract.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Intraoral incision and drainage of abscess

D7510
Use when incision and drainage are performed for the abscess.

Molar endodontic therapy

D3330
Use when root canal therapy is performed.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Periapical abscess with sinus

K04.6
Presence of a sinus tract confirmed by clinical examination or imaging.

Periapical abscess without sinus

K04.7
Absence of a sinus tract.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Abscessed Tooth to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K04.7.

Impact

Clinical: Misdiagnosis of abscess type, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials

Mitigation Strategy

Use checklists for documentation, Regular training on documentation standards

Impact

Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data recording.

Mitigation Strategy

Ensure documentation specifies presence or absence of sinus tract.

Impact

Failure to document sinus tract can lead to incorrect coding.

Mitigation Strategy

Ensure thorough documentation of clinical findings and imaging.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Abscessed Tooth, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Abscessed Tooth

Use these documentation templates to ensure complete and accurate documentation for Abscessed Tooth. These templates include all required elements for proper coding and billing.

Endodontic Treatment for Abscess

Specialty: Endodontics

Required Elements

  • Subjective: Patient's pain description
  • Objective: Clinical findings
  • Assessment: Diagnosis
  • Plan: Treatment performed

Example Documentation

**Subjective**: Pt reports throbbing pain in LLQ x3 days. **Objective**: Tooth #30: + percussion, - mobility. **Assessment**: K04.7, Necrotic pulp. **Plan**: D3330, D7510.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has a tooth abscess.
Good Documentation Example
Patient presents with fluctuant buccal swelling adjacent to tooth #30. CBCT reveals 5mm periapical radiolucency without sinus tract. Diagnosis: K04.7.
Explanation
The good example provides specific clinical findings and imaging results supporting the diagnosis.

Need help with ICD-10 coding for Abscessed Tooth? Ask your questions below.

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