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:
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
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K04.7 | Periapical abscess without sinus | Use when imaging confirms abscess confined to periapical region without sinus tract. |
|
| K04.6 | Periapical abscess with sinus | Use when a sinus tract is present and documented. |
|
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
Primary ICD-10-CM Codes for abscess tooth
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.
K04.6 - Periapical abscess with sinus
Use when a sinus tract is present and documented.
Applicable To
- Periapical abscess with sinus tract
Excludes
- Periapical abscess without sinus (K04.7)
Clinical Validation Requirements
- Radiographic or clinical evidence of sinus tract
Coding Notes
Document the presence of a sinus tract clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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: EndodonticsRequired Elements
- Subjective: Patient's pain description
- Objective: Clinical findings
- Assessment: Diagnosis
- Plan: Treatment performed
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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