ICD-10 Coding for Dentoalveolar Abscess(K04.6, K04.7)
Complete ICD-10-CM coding and documentation guide for Dentoalveolar Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dentoalveolar Abscess
K04.6-K04.7Primary Range
ICD-10 codes for periapical abscess with and without sinus
These codes are used to classify dentoalveolar abscesses based on the presence or absence of a sinus tract.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K04.6 | Periapical abscess with sinus | Use when a sinus tract is present with the abscess. |
|
| K04.7 | Periapical abscess without sinus | Use when there is no sinus tract present with the abscess. |
|
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 dentoalveolar abscess with sinus
Essential facts and insights about Dentoalveolar Abscess
Primary ICD-10-CM Codes for dentoalveolar abscess
Decision Criteria
clinical Criteria
- Sinus tract present with purulent drainage
Applicable To
- Dentoalveolar abscess with draining sinus
Excludes
- Periodontal abscess (K05.6)
Clinical Validation Requirements
- Presence of sinus tract
- Purulent drainage observed
- Fistula tract traced to tooth/root
Code-Specific Risks
- Confusion with K04.7 if sinus is not documented
Coding Notes
- Ensure documentation clearly states the presence of a sinus tract.
K04.7 - Periapical abscess without sinus
Use when there is no sinus tract present with the abscess.
Applicable To
- Dentoalveolar abscess without draining sinus
Excludes
- Periodontal abscess (K05.6)
Clinical Validation Requirements
- No sinus tract identified
- Localized fluctuant swelling
- No drainage pathway observed
Coding Notes
Ensure documentation clearly states the absence of a sinus tract.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Abnormal findings during dental exam
Z01.21Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dentoalveolar Abscess to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K04.6.
Impact
Clinical: Leads to incorrect diagnosis coding., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Ensure thorough clinical examination and documentation., Use templates to capture all necessary details.
Impact
Reimbursement: Incorrect coding may lead to reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation includes the presence of a sinus tract if observed.
Impact
Failure to document sinus tract presence can lead to audit discrepancies.
Mitigation Strategy
Implement standardized documentation templates.
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 Dentoalveolar Abscess, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dentoalveolar Abscess
Use these documentation templates to ensure complete and accurate documentation for Dentoalveolar Abscess. These templates include all required elements for proper coding and billing.
Endodontic abscess management
Specialty: DentistryRequired Elements
- Sinus tract status
- Drainage characteristics
- Odontogenic source
- Imaging correlation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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