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ICD-10 Guide
ICD-10 CodesK02.53

K02.53

Billable

Dental caries on pit and fissure surface penetrating into pulp

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

Code Description

ICD-10 K02.53 is a billable code used to indicate a diagnosis of dental caries on pit and fissure surface penetrating into pulp.

Key Diagnostic Point:

K02.53 refers to dental caries that have progressed to the point of penetrating the pulp of a tooth, specifically on the pit and fissure surfaces. Clinically, this condition presents with symptoms such as toothache, sensitivity to temperature changes, and potential swelling in the surrounding gum tissue. The anatomy involved includes the enamel, dentin, and pulp of the tooth, where the carious lesion begins on the outer surfaces and advances inward. Disease progression typically starts with demineralization of the enamel, leading to cavitation and subsequent invasion of the dentin, ultimately reaching the pulp, which contains nerves and blood vessels. Diagnostic considerations include clinical examination, radiographic assessment to evaluate the extent of caries, and possibly pulp vitality tests. Early detection and intervention are crucial to prevent further complications, such as abscess formation or tooth loss.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical and radiographic evaluation.
  • Treatment complexity: May involve restorative procedures or endodontic treatment.
  • Documentation requirements: Detailed records of clinical findings and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from other types of dental caries.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of caries.
  • Documentation gaps: Incomplete records of symptoms or treatment rationale.
  • Billing challenges: Potential denials if the extent of the caries is not clearly documented.

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 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 K02.53 lies in its potential to lead to severe pain and complications if left untreated, impacting patient quality of life. From a population health perspective, untreated dental caries can contribute to broader health issues, including systemic infections and increased healthcare utilization. Quality measures focus on timely intervention and effective management of dental caries to reduce the incidence of advanced dental disease and improve overall oral health outcomes.

ICD-9 vs ICD-10

The clinical significance of K02.53 lies in its potential to lead to severe pain and complications if left untreated, impacting patient quality of life. From a population health perspective, untreated dental caries can contribute to broader health issues, including systemic infections and increased healthcare utilization. Quality measures focus on timely intervention and effective management of dental caries to reduce the incidence of advanced dental disease and improve overall oral health outcomes.

Reimbursement & Billing Impact

reimbursement issues.

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 K02.53?

K02.53 specifically covers dental caries that have penetrated the pulp on pit and fissure surfaces, indicating a severe level of decay that requires immediate attention.

When should K02.53 be used instead of related codes?

K02.53 should be used when there is clear evidence of pulp involvement due to caries, differentiating it from codes for superficial caries that do not affect the pulp.

What documentation supports K02.53?

Documentation should include clinical findings of caries, radiographic images showing pulp involvement, and treatment plans outlining the necessary interventions.