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ICD-10 Guide
ICD-10 CodesK04.2

K04.2

Billable

Pulp degeneration

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

Code Description

ICD-10 K04.2 is a billable code used to indicate a diagnosis of pulp degeneration.

Key Diagnostic Point:

Pulp degeneration refers to the pathological changes occurring in the dental pulp, which is the innermost part of a tooth containing nerves and blood vessels. Clinically, pulp degeneration can manifest as pain, sensitivity to temperature changes, discoloration of the tooth, and in severe cases, abscess formation. The anatomy involved includes the dental pulp, surrounding dentin, and enamel. Disease progression typically begins with pulpitis, which can be reversible or irreversible, leading to pulp necrosis if untreated. Diagnostic considerations include clinical examination, patient history, and radiographic imaging to assess the extent of degeneration and rule out other dental conditions. Early diagnosis is crucial to prevent complications such as tooth loss or systemic infections.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

Endodontics

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

Pulp degeneration can significantly affect patient quality of life, leading to pain and potential tooth loss. Understanding the epidemiology of dental pulp diseases can help in developing preventive strategies and improving population health outcomes. Effective management of pulp degeneration can reduce healthcare utilization patterns associated with dental emergencies and enhance overall dental care quality.

ICD-9 vs ICD-10

Pulp degeneration can significantly affect patient quality of life, leading to pain and potential tooth loss. Understanding the epidemiology of dental pulp diseases can help in developing preventive strategies and improving population health outcomes. Effective management of pulp degeneration can reduce healthcare utilization patterns associated with dental emergencies and enhance overall dental care quality.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure codes used align with the diagnosis. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining thorough clinical notes, obtaining pre-authorization when necessary, and ensuring that all coding is accurate and specific to the services rendered.

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 K04.2?

K04.2 covers conditions related to pulp degeneration, including irreversible pulpitis and pulp necrosis. It is important to differentiate these from other pulp-related conditions such as K04.1 (pulpitis) and K04.3 (pulp necrosis).

When should K04.2 be used instead of related codes?

K04.2 should be used when there is clear evidence of pulp degeneration, particularly when irreversible changes are noted. It is essential to document the clinical findings that support this diagnosis.

What documentation supports K04.2?

Documentation should include clinical notes detailing symptoms, diagnostic imaging results, and treatment plans. Radiographs showing pulp involvement and any relevant patient history are critical for substantiating the diagnosis.