ICD-10 Coding for Gingivitis(K05.10, K05.11)
Complete ICD-10-CM coding and documentation guide for Gingivitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gingivitis
K05.0-K05.1Primary Range
Gingivitis and periodontal diseases
This range includes codes for different types of gingivitis, both acute and chronic, which are essential for accurate diagnosis and treatment documentation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K05.10 | Chronic plaque-induced gingivitis | Use when gingivitis is chronic and caused by plaque accumulation. |
|
| K05.11 | Chronic non-plaque induced gingivitis | Use when gingivitis is chronic and not caused by plaque. |
|
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 chronic plaque-induced gingivitis
Essential facts and insights about Gingivitis
Primary ICD-10-CM Codes for gingivitis
Decision Criteria
clinical Criteria
- Presence of plaque and bleeding on probing without bone loss
Clinical Validation Requirements
- Presence of plaque
- Bleeding on probing
- No radiographic bone loss
Code-Specific Risks
- Misclassification as periodontitis if bone loss is present
Coding Notes
- Ensure documentation specifies plaque-induced nature and absence of bone loss.
K05.11 - Chronic non-plaque induced gingivitis
Use when gingivitis is chronic and not caused by plaque.
Applicable To
- Gingivitis due to systemic conditions
Excludes
- Acute gingivitis (K05.0-)
- Periodontitis (K05.3-)
Clinical Validation Requirements
- Absence of plaque
- Presence of systemic condition or medication causing gingival inflammation
Coding Notes
Document the specific non-plaque cause of gingivitis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Dental examination and cleaning
Z01.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gingivitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K05.10.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Always document the cause of gingivitis., Use specific ICD-10 codes.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Specify whether gingivitis is plaque-induced or non-plaque induced.
Impact
Using K05.1 instead of specific codes like K05.10 or K05.11.
Mitigation Strategy
Ensure documentation specifies the type of gingivitis.
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 Gingivitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gingivitis
Use these documentation templates to ensure complete and accurate documentation for Gingivitis. These templates include all required elements for proper coding and billing.
Chronic plaque-induced gingivitis
Specialty: DentistryRequired Elements
- Presence of plaque
- Bleeding on probing
- Radiographic findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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