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ICD-10 Guide
ICD-10 CodesK02.52

K02.52

Billable

Dental caries on pit and fissure surface penetrating into dentin

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

Code Description

ICD-10 K02.52 is a billable code used to indicate a diagnosis of dental caries on pit and fissure surface penetrating into dentin.

Key Diagnostic Point:

K02.52 refers to dental caries that specifically affect the pit and fissure surfaces of teeth, penetrating into the dentin layer. Clinically, this condition presents as localized areas of decay that may appear as dark spots or holes on the tooth surface, often accompanied by sensitivity to temperature changes or sweet foods. The anatomy involved includes the enamel, which is the outer protective layer of the tooth, and the dentin, which is the underlying layer that contains nerve endings. As the caries progress, they can lead to more severe dental issues, including pulpitis or abscess formation if left untreated. Diagnosis typically involves visual examination, radiographic imaging, and patient-reported symptoms. Early detection is crucial to prevent further deterioration and potential tooth loss. Treatment may involve restorative procedures such as fillings or crowns, depending on the extent of the decay.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical examination and possibly radiographic evaluation.
  • Treatment complexity: May involve simple restorative procedures or more complex interventions depending on severity.
  • Documentation requirements: Requires detailed documentation of clinical findings and treatment plans.
  • Coding specificity: Specific to pit and fissure caries, necessitating precise coding to avoid misclassification.

Audit Risk Factors

  • Common coding errors: Misclassification of caries types or locations.
  • Documentation gaps: Incomplete records of clinical findings or treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the level of care provided.

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 K02.52 lies in its potential to lead to more severe dental complications if not addressed promptly. Population health impact includes the prevalence of dental caries, which remains a common issue affecting various demographics, particularly children and adolescents. Quality measures focus on preventive care and early intervention to reduce the incidence of caries, thereby improving overall oral health and reducing healthcare utilization for more complex dental treatments.

ICD-9 vs ICD-10

The clinical significance of K02.52 lies in its potential to lead to more severe dental complications if not addressed promptly. Population health impact includes the prevalence of dental caries, which remains a common issue affecting various demographics, particularly children and adolescents. Quality measures focus on preventive care and early intervention to reduce the incidence of caries, thereby improving overall oral health and reducing healthcare utilization for more complex dental treatments.

Reimbursement & Billing Impact

Reimbursement considerations include verifying patient eligibility and coverage for dental procedures. Common denials may arise from insufficient documentation or coding errors, so it is crucial to maintain thorough records of clinical findings and treatment plans. Best practices include using precise codes, ensuring that the treatment aligns with the diagnosis, and regularly reviewing coding updates to stay compliant with payer requirements.

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 K02.52?

K02.52 specifically covers dental caries that have penetrated into the dentin on the pit and fissure surfaces of teeth. This includes carious lesions that may require restorative treatment.

When should K02.52 be used instead of related codes?

K02.52 should be used when there is clear evidence of caries on the pit and fissure surfaces that have progressed into the dentin. It is important to differentiate from codes that describe caries limited to enamel or other surfaces.

What documentation supports K02.52?

Documentation should include clinical findings from examinations, radiographic evidence showing the extent of decay, and treatment plans that outline the necessary restorative procedures.