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ICD-10 Guide
ICD-10 CodesK04.01

K04.01

Billable

Reversible pulpitis

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

Code Description

ICD-10 K04.01 is a billable code used to indicate a diagnosis of reversible pulpitis.

Key Diagnostic Point:

Reversible pulpitis is an inflammatory condition affecting the dental pulp, characterized by the pulp's ability to return to a normal state once the irritant is removed. Clinically, patients may present with sharp, transient pain in response to thermal stimuli, such as hot or cold, which resolves quickly upon removal of the stimulus. The anatomy involved includes the dental pulp, which is the innermost part of the tooth containing nerves and blood vessels. Disease progression typically begins with enamel or dentin caries that irritate the pulp, leading to inflammation. If untreated, reversible pulpitis can progress to irreversible pulpitis, where the pulp becomes necrotic, necessitating more invasive treatment. Diagnostic considerations include clinical examination, patient history, and diagnostic tests such as percussion and thermal sensitivity tests. Radiographic evaluation may also be necessary to rule out periapical pathology.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of dental anatomy and pathology.
  • Treatment complexity: May involve conservative management or referral for endodontic treatment.
  • Documentation requirements: Detailed clinical notes and diagnostic findings are essential.
  • Coding specificity: Requires precise coding to differentiate from irreversible pulpitis (K04.02).

Audit Risk Factors

  • Common coding errors: Misclassification as irreversible pulpitis.
  • Documentation gaps: Incomplete patient history or lack of diagnostic evidence.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

Reversible pulpitis has significant clinical implications as it can affect patient quality of life due to pain and discomfort. Understanding and managing this condition can reduce the need for more invasive procedures, thus impacting healthcare utilization patterns positively. Epidemiologically, it is important to monitor the prevalence of dental caries, which is a primary cause of reversible pulpitis, to improve population health outcomes.

ICD-9 vs ICD-10

Reversible pulpitis has significant clinical implications as it can affect patient quality of life due to pain and discomfort. Understanding and managing this condition can reduce the need for more invasive procedures, thus impacting healthcare utilization patterns positively. Epidemiologically, it is important to monitor the prevalence of dental caries, which is a primary cause of reversible pulpitis, to improve population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation to justify the diagnosis and treatment. Common denials may arise from insufficient documentation or incorrect coding, particularly if the condition is misclassified. Best practices include ensuring that all clinical notes are detailed and that the rationale for treatment aligns with the diagnosis.

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 K04.01?

K04.01 specifically covers reversible pulpitis, which is characterized by inflammation of the dental pulp that can resolve with appropriate treatment. It does not include irreversible pulpitis or other dental conditions.

When should K04.01 be used instead of related codes?

K04.01 should be used when the clinical findings indicate reversible pulpitis, particularly when the patient exhibits transient pain that resolves after stimulus removal. If the pulp is necrotic or the pain is persistent, K04.02 should be considered.

What documentation supports K04.01?

Documentation should include a thorough clinical examination, patient symptoms, diagnostic tests results, and treatment plans. Evidence of transient pain response to stimuli and absence of irreversible damage is crucial.