ICD-10 Coding for Gum Pain(K05.6, K06.01, G89.29)
Complete ICD-10-CM coding and documentation guide for Gum Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gum Pain
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K05.6 | Periodontal disease, unspecified | Use when gum pain is due to generalized inflammation without bone loss. |
|
| K06.01 | Localized gingival recession | Use when gum pain is due to localized gingival recession. |
|
| G89.29 | Other chronic pain | Use when chronic pain management is the primary focus. |
|
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 gum pain
Essential facts and insights about Gum Pain
Primary ICD-10-CM Codes for gum pain
Decision Criteria
clinical Criteria
- No bone loss on radiographs
Applicable To
- Gingivitis
- Periodontitis without bone loss
Excludes
- Periodontitis with bone loss (K05.3)
Clinical Validation Requirements
- Redness and bleeding on probing
- Plaque retention
- No attachment loss
Code-Specific Risks
- Misclassification if bone loss is present
Coding Notes
- Ensure documentation specifies absence of bone loss.
K06.01 - Localized gingival recession
Use when gum pain is due to localized gingival recession.
Applicable To
- Recession in ≤30% of sites
Excludes
- Generalized gingival recession (K06.02)
Clinical Validation Requirements
- Recession measurements (e.g., 3mm recession on specific teeth)
Coding Notes
Document specific teeth and recession measurements.
G89.29 - Other chronic pain
Use when chronic pain management is the primary focus.
Applicable To
- Chronic gum pain
Excludes
- Acute pain (G89.1)
Clinical Validation Requirements
- Pain duration >3 months
- Failed conservative treatments
Coding Notes
Ensure pain management is documented as primary reason for encounter.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other chronic pain
G89.29Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gum Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K05.6.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of detail.
Mitigation Strategy
Use structured templates for documentation., Ensure all clinical findings are recorded.
Impact
Reimbursement: Incorrect code may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Use K05.3 if bone loss is present.
Impact
Incorrect use of G89 codes without proper documentation.
Mitigation Strategy
Ensure pain management is documented as primary reason for encounter.
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 Gum Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gum Pain
Use these documentation templates to ensure complete and accurate documentation for Gum Pain. These templates include all required elements for proper coding and billing.
Generalized Gingivitis
Specialty: DentistryRequired Elements
- Subjective: Patient's description of pain
- Objective: Clinical findings including bleeding on probing
- Assessment: Diagnosis based on clinical findings
- Plan: Treatment plan including scaling and oral hygiene instruction
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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