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ICD-10 Guide
ICD-10 CodesK02.6

K02.6

Non-billable

Dental caries on smooth surface

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

Code Description

ICD-10 K02.6 is a used to indicate a diagnosis of dental caries on smooth surface.

Key Diagnostic Point:

Dental caries on smooth surfaces, classified under K02.6, refers to the localized destruction of tooth structure due to the demineralization caused by acids produced by bacteria in dental plaque. Clinically, this condition presents as white spots or lesions on the smooth surfaces of teeth, particularly on the buccal and lingual surfaces. The anatomy involved includes the enamel, dentin, and potentially the pulp if the caries progresses untreated. Disease progression typically starts with demineralization of enamel, leading to cavitation if not addressed. Diagnostic considerations include visual examination, radiographic assessment, and possibly the use of diagnostic tools like fiber-optic transillumination. Early detection is crucial to prevent further decay and potential complications such as pulpitis or abscess formation. Treatment options range from preventive measures, such as fluoride application, to restorative procedures like fillings, depending on the extent of the caries.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical judgment and sometimes imaging.
  • Treatment complexity: Varies from simple preventive care to more complex restorative procedures.
  • Documentation requirements: Requires clear documentation of findings and treatment plans.
  • Coding specificity: Moderate, as it is specific to smooth surface caries but may require differentiation from other types.

Audit Risk Factors

  • Common coding errors: Misidentification of caries type or surface.
  • 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 K02.6 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, which is a common condition affecting a significant portion of the population, particularly children and adolescents. Quality measures focus on preventive care and early intervention to reduce the incidence of caries, thereby improving healthcare utilization patterns and reducing costs associated with advanced dental treatments.

ICD-9 vs ICD-10

The clinical significance of K02.6 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, which is a common condition affecting a significant portion of the population, particularly children and adolescents. Quality measures focus on preventive care and early intervention to reduce the incidence of caries, thereby improving healthcare utilization patterns and reducing costs associated with advanced dental treatments.

Reimbursement & Billing Impact

Reimbursement considerations include verifying patient eligibility and understanding the payer's specific requirements for dental caries treatment. Common denials may arise from insufficient documentation or incorrect coding. Best practices include thorough documentation of clinical findings, treatment rationale, and follow-up care to support the claim and reduce the risk of audits.

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 K02.6?

K02.6 specifically covers dental caries that occur on smooth surfaces of teeth, which may include caries on the buccal, lingual, and interproximal areas. It does not cover caries on occlusal surfaces or root surfaces.

When should K02.6 be used instead of related codes?

K02.6 should be used when the caries is specifically identified as occurring on smooth surfaces. If the caries is on occlusal surfaces, K02.5 should be used instead. Accurate identification of the surface type is essential for proper coding.

What documentation supports K02.6?

Documentation should include clinical findings from examinations, radiographic evidence if applicable, treatment plans, and any preventive measures taken. Detailed notes on the extent of caries and surfaces involved are crucial.