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ICD-10 Guide
ICD-10 CodesK04.3

K04.3

Billable

Abnormal hard tissue formation in pulp

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

Code Description

ICD-10 K04.3 is a billable code used to indicate a diagnosis of abnormal hard tissue formation in pulp.

Key Diagnostic Point:

K04.3 refers to abnormal hard tissue formation in the pulp, a condition primarily affecting the dental pulp tissue within the tooth. This abnormality can manifest as calcifications or hypercementosis, leading to potential complications such as pulp necrosis or dental abscesses. Clinically, patients may present with symptoms including tooth sensitivity, pain, or swelling, which can indicate underlying pulpitis or other dental issues. The anatomy involved includes the dental pulp, which is the innermost part of the tooth containing nerves and blood vessels. Disease progression may vary; in some cases, the abnormal hard tissue formation can lead to irreversible pulpitis, necessitating endodontic intervention. Diagnostic considerations include clinical examination, radiographic evaluation, and possibly pulp vitality tests to assess the health of the pulp. Understanding the etiology of this condition is crucial, as it may be associated with trauma, chronic inflammation, or systemic conditions affecting mineralization.

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

The clinical significance of K04.3 lies in its potential to lead to more severe dental complications if left untreated, impacting patient quality of life and increasing healthcare utilization. Understanding this condition can help in developing preventive strategies and improving overall dental health outcomes in the population.

ICD-9 vs ICD-10

The clinical significance of K04.3 lies in its potential to lead to more severe dental complications if left untreated, impacting patient quality of life and increasing healthcare utilization. Understanding this condition can help in developing preventive strategies and improving overall dental health outcomes in the population.

Reimbursement & Billing Impact

Reimbursement may be affected by the specificity of the diagnosis and the completeness of the documentation. Common denials may arise from insufficient evidence of the condition or failure to follow up with necessary treatments. Best practices include maintaining thorough records of patient interactions, treatment rationale, and any diagnostic imaging performed.

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 K04.3?

K04.3 covers conditions related to abnormal hard tissue formation in the dental pulp, including calcifications and hypercementosis. These conditions can lead to complications such as pulpitis or abscess formation.

When should K04.3 be used instead of related codes?

K04.3 should be used when there is clear evidence of abnormal hard tissue formation in the pulp, differentiating it from other dental conditions such as pulpitis (K04.2) or dental caries (K02).

What documentation supports K04.3?

Documentation should include clinical findings, radiographic evidence of abnormal hard tissue, patient symptoms, and any relevant treatment history to support the diagnosis of K04.3.