ICD-10 Coding for Tooth Infection(K04.7, K04.6)
Complete ICD-10-CM coding and documentation guide for Tooth Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tooth Infection
K04.6-K04.7Primary Range
Diseases of pulp and periapical tissues
This range includes codes for periapical abscesses with and without sinus, which are common manifestations of tooth infections.
Dental caries
Dental caries can lead to tooth infections and are often coded alongside abscesses.
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 there is a confirmed periapical abscess without a sinus tract. |
|
| K04.6 | Periapical abscess with sinus | Use when a sinus tract is 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 tooth infection
Essential facts and insights about Tooth Infection
Primary ICD-10-CM Codes for tooth infection
Decision Criteria
clinical Criteria
- Absence of sinus tract confirmed by clinical examination and imaging.
Applicable To
- Periapical abscess without sinus tract
Excludes
- Periapical abscess with sinus (K04.6)
Clinical Validation Requirements
- Percussion sensitivity
- Radiographic PDL widening
- Absence of sinus tract
Code-Specific Risks
- Misidentifying the presence of a sinus tract can lead to incorrect coding.
Coding Notes
- Ensure radiographic evidence supports the absence of a sinus tract.
K04.6 - Periapical abscess with sinus
Use when a sinus tract is present with the abscess.
Applicable To
- Periapical abscess with sinus tract
Excludes
- Periapical abscess without sinus (K04.7)
Clinical Validation Requirements
- Visible sinus tract
- Purulent drainage
- Fistulation
Coding Notes
Document the presence of a sinus tract with clinical and imaging evidence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Dental infection control
Z76.82Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Tooth Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K04.7.
Impact
Clinical: Leads to incorrect treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Thorough clinical examination, Detailed documentation
Impact
Reimbursement: May lead to claim denials due to lack of specificity., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Reduces the accuracy of health records.
Mitigation Strategy
Document specific conditions such as 'periapical abscess with sinus tract'.
Impact
Using unspecified codes for tooth infections.
Mitigation Strategy
Ensure detailed documentation and correct code selection.
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 Tooth Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tooth Infection
Use these documentation templates to ensure complete and accurate documentation for Tooth Infection. These templates include all required elements for proper coding and billing.
Documenting a periapical abscess without sinus
Specialty: DentistryRequired Elements
- Subjective: Patient's pain description
- Objective: Clinical findings
- Assessment: Diagnosis with ICD-10 code
- Plan: Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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