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ICD-10 Guide
ICD-10 CodesK04.90

K04.90

Billable

Unspecified diseases of pulp and periapical tissues

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

Code Description

ICD-10 K04.90 is a billable code used to indicate a diagnosis of unspecified diseases of pulp and periapical tissues.

Key Diagnostic Point:

K04.90 refers to unspecified diseases of pulp and periapical tissues, which are critical components of dental anatomy. The pulp is the innermost part of the tooth containing nerves and blood vessels, while periapical tissues surround the root of the tooth. Diseases affecting these areas can lead to significant clinical presentations, including toothache, swelling, and sensitivity to temperature changes. Common causes include dental caries, trauma, and periodontal disease. The progression of these diseases can lead to pulp necrosis, abscess formation, and potential tooth loss if not addressed promptly. Diagnostic considerations involve clinical examination, radiographic imaging, and possibly pulp vitality tests to assess the health of the pulp. Early diagnosis and intervention are crucial to prevent further complications and preserve dental health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and imaging for accurate diagnosis.
  • Treatment complexity: May involve endodontic procedures or extraction depending on severity.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Limited specificity as it is an unspecified code.

Audit Risk Factors

  • Common coding errors: Misuse of unspecified codes when more specific codes are available.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential for claim denials due to lack of specificity.

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

The clinical significance of K04.90 lies in its potential to indicate underlying dental issues that, if left untreated, can lead to more severe health complications. Population health impact includes the prevalence of dental diseases and their contribution to overall health disparities. Quality measures may focus on timely diagnosis and treatment of dental conditions, while healthcare utilization patterns reflect the need for dental care services in managing pulp and periapical diseases. Epidemiologically, understanding these conditions can help in developing preventive strategies and improving oral health outcomes.

ICD-9 vs ICD-10

The clinical significance of K04.90 lies in its potential to indicate underlying dental issues that, if left untreated, can lead to more severe health complications. Population health impact includes the prevalence of dental diseases and their contribution to overall health disparities. Quality measures may focus on timely diagnosis and treatment of dental conditions, while healthcare utilization patterns reflect the need for dental care services in managing pulp and periapical diseases. Epidemiologically, understanding these conditions can help in developing preventive strategies and improving oral health outcomes.

Reimbursement & Billing Impact

reimbursement and address any issues promptly.

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 K04.90?

K04.90 encompasses a range of unspecified diseases affecting the pulp and periapical tissues, including but not limited to pulpitis, periapical abscesses, and pulp necrosis that are not otherwise classified.

When should K04.90 be used instead of related codes?

K04.90 should be used when the specific condition affecting the pulp or periapical tissues is not clearly defined or documented. If a more specific diagnosis is available, those codes should be prioritized.

What documentation supports K04.90?

Documentation should include clinical findings, patient history, radiographic evidence, and any diagnostic tests performed to support the diagnosis of unspecified pulp and periapical diseases.