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ICD-10 Guide
ICD-10 CodesK08.539

K08.539

Billable

Fractured dental restorative material, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K08.539 is a billable code used to indicate a diagnosis of fractured dental restorative material, unspecified.

Key Diagnostic Point:

K08.539 refers to fractured dental restorative material, unspecified, which is a condition that arises when dental materials used in restorative procedures, such as fillings, crowns, or bridges, become compromised due to fracture. The clinical presentation may include pain, sensitivity, or functional impairment in the affected tooth or teeth. The anatomy involved typically includes the dental hard tissues (enamel, dentin) and the restorative materials themselves, which may be composed of composites, ceramics, or metals. Disease progression can vary; if left untreated, fractured restorative materials can lead to further dental complications, including secondary caries, pulpitis, or tooth loss. Diagnostic considerations include clinical examination, patient history, and possibly radiographic evaluation to assess the extent of the fracture and its impact on surrounding structures. Proper identification of the fractured material is crucial for effective treatment planning and to avoid further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misidentifying the type of restorative material.
  • Documentation gaps may arise if the fracture's impact on function is not clearly noted.
  • Billing challenges can occur if the code is used without adequate clinical justification.

Specialty Focus

Medical Specialties

Dentistry

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Oral and Maxillofacial Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K08.539 lies in its potential to lead to further dental complications if not addressed promptly. Population health impact includes the prevalence of dental restorative material failures, which can affect a significant portion of the population, particularly among those with a history of dental work. Quality measures may include tracking the incidence of restorative material fractures and their management, while healthcare utilization patterns may reflect increased visits to dental providers for repair or replacement of fractured restorations. Epidemiological considerations highlight the importance of understanding the materials used in dental restorations and their longevity.

ICD-9 vs ICD-10

The clinical significance of K08.539 lies in its potential to lead to further dental complications if not addressed promptly. Population health impact includes the prevalence of dental restorative material failures, which can affect a significant portion of the population, particularly among those with a history of dental work. Quality measures may include tracking the incidence of restorative material fractures and their management, while healthcare utilization patterns may reflect increased visits to dental providers for repair or replacement of fractured restorations. Epidemiological considerations highlight the importance of understanding the materials used in dental restorations and their longevity.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for dental procedures and ensuring that the treatment plan aligns with the documented findings. Common denials may arise from insufficient documentation or failure to specify the type of restorative material involved. Coding best practices recommend using the most specific code available and ensuring that all relevant clinical information is included in the claim to minimize the risk of audits and denials.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K08.539?

K08.539 covers any unspecified fractures of dental restorative materials, including those that may not be clearly defined as anterior or posterior fractures. It is used when the type of restorative material or the specific location of the fracture is not documented.

When should K08.539 be used instead of related codes?

K08.539 should be used when the fracture of the dental restorative material does not fit into the more specific categories of anterior or posterior fractures, or when the specific type of restorative material is unknown.

What documentation supports K08.539?

Documentation should include a detailed clinical examination report, patient history indicating the presence of restorative materials, and any imaging studies that demonstrate the fracture. Notes should clearly describe the symptoms and functional impact on the patient.