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ICD-10 Guide
ICD-10 CodesK02.5

K02.5

Non-billable

Dental caries on pit and fissure surface

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

Code Description

ICD-10 K02.5 is a used to indicate a diagnosis of dental caries on pit and fissure surface.

Key Diagnostic Point:

K02.5 refers to dental caries specifically affecting the pit and fissure surfaces of teeth. This condition is characterized by the demineralization of enamel and subsequent decay that occurs in the grooves and crevices of the teeth, particularly molars and premolars. Clinically, patients may present with sensitivity to temperature changes, pain when chewing, or visible discoloration of the affected teeth. The anatomy involved includes the enamel, dentin, and potentially the pulp if the caries progresses. Disease progression typically begins with the initial demineralization of enamel, leading to cavitation if untreated. Diagnostic considerations include clinical examination, radiographic evaluation, and patient history to assess risk factors such as dietary habits and oral hygiene practices. Early detection and intervention are crucial to prevent further complications, including pulpitis or abscess formation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical examination and possibly radiographs for accurate diagnosis.
  • Treatment complexity: May involve simple restorative procedures or more complex interventions depending on the extent of decay.
  • Documentation requirements: Requires detailed documentation of clinical findings and treatment plans.
  • Coding specificity: Specific to pit and fissure surfaces, necessitating precise coding to avoid misclassification.

Audit Risk Factors

  • Common coding errors: Misidentification of the surface affected or using a more general code.
  • Documentation gaps: Incomplete records of clinical findings or treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the severity or extent of the condition.

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 K02.5 lies in its potential to lead to more severe dental issues if left untreated, impacting overall oral health. Population health impact includes the prevalence of dental caries as a common condition, which can affect quality of life and increase healthcare utilization. Quality measures may focus on preventive care and early intervention strategies, while epidemiological considerations highlight the importance of addressing risk factors such as diet and access to dental care.

ICD-9 vs ICD-10

The clinical significance of K02.5 lies in its potential to lead to more severe dental issues if left untreated, impacting overall oral health. Population health impact includes the prevalence of dental caries as a common condition, which can affect quality of life and increase healthcare utilization. Quality measures may focus on preventive care and early intervention strategies, while epidemiological considerations highlight the importance of addressing risk factors such as diet and access to dental care.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed treatment plans and evidence of clinical necessity. Common denials may arise from insufficient documentation or failure to demonstrate the extent of the caries. Best practices include thorough documentation of clinical findings, treatment rationale, and patient education efforts regarding oral hygiene and dietary habits to prevent further decay.

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 K02.5?

K02.5 covers dental caries localized to the pit and fissure surfaces of teeth, which may include early-stage caries that have not yet progressed to deeper structures. It is important to differentiate this from other types of caries affecting smooth surfaces or root surfaces.

When should K02.5 be used instead of related codes?

K02.5 should be used when the caries specifically affects the pit and fissure surfaces. If the caries is located on smooth surfaces or involves other areas, different codes such as K02.3 or K02.4 should be considered.

What documentation supports K02.5?

Documentation should include clinical findings from the dental examination, radiographic evidence showing the extent of caries, and a treatment plan that outlines the proposed intervention. Notes on patient history and risk factors for caries should also be included.