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ICD-10 Guide
ICD-10 CodesK05.00

K05.00

Billable

Acute gingivitis, plaque induced

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

Code Description

ICD-10 K05.00 is a billable code used to indicate a diagnosis of acute gingivitis, plaque induced.

Key Diagnostic Point:

Acute gingivitis, plaque induced, is characterized by inflammation of the gingiva, primarily caused by the accumulation of dental plaque. Clinically, patients may present with symptoms such as redness, swelling, and bleeding of the gums, particularly during brushing or flossing. The anatomy involved includes the gingival tissue surrounding the teeth, which can become inflamed due to bacterial toxins from plaque. If left untreated, acute gingivitis can progress to more severe periodontal diseases, potentially leading to tooth loss. Diagnostic considerations include a thorough oral examination, assessment of plaque levels, and patient history to identify risk factors such as poor oral hygiene, smoking, and systemic conditions like diabetes. Treatment typically involves improved oral hygiene practices, professional dental cleanings, and patient education on plaque control. Regular follow-up is essential to monitor the resolution of symptoms and prevent recurrence.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - diagnosis is straightforward based on clinical presentation and examination.
  • Treatment complexity: Low - treatment primarily involves non-invasive measures.
  • Documentation requirements: Low - basic documentation of symptoms and treatment suffices.
  • Coding specificity: Medium - while specific, it is clear and straightforward.

Audit Risk Factors

  • Common coding errors: Misclassification as chronic gingivitis.
  • Documentation gaps: Incomplete records of patient history or treatment plans.
  • Billing challenges: Denials may occur if documentation does not clearly support the diagnosis.

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

Primary care

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

Acute gingivitis has significant clinical implications, as it can lead to more severe periodontal diseases if not addressed promptly. Population health impact includes a high prevalence of gingivitis among adults, which can affect overall health and quality of life. Effective management of gingivitis contributes to improved oral health outcomes, reduced healthcare utilization for advanced periodontal treatments, and better adherence to quality measures in dental care.

ICD-9 vs ICD-10

Acute gingivitis has significant clinical implications, as it can lead to more severe periodontal diseases if not addressed promptly. Population health impact includes a high prevalence of gingivitis among adults, which can affect overall health and quality of life. Effective management of gingivitis contributes to improved oral health outcomes, reduced healthcare utilization for advanced periodontal treatments, and better adherence to quality measures in dental care.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure codes used align with the diagnosis. Common denials may arise from insufficient documentation of the patient's symptoms or treatment plan. Best practices include maintaining detailed records of patient interactions, treatment efficacy, and follow-up care to support claims and reduce audit risks.

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 K05.00?

K05.00 specifically covers acute gingivitis that is plaque-induced, characterized by inflammation and bleeding of the gums due to plaque accumulation. It does not cover other forms of gingivitis that may be caused by systemic diseases or other factors.

When should K05.00 be used instead of related codes?

K05.00 should be used when the diagnosis is specifically acute gingivitis caused by plaque. If the condition is chronic or associated with other etiologies, other codes such as K05.01 or K05.02 should be considered.

What documentation supports K05.00?

Documentation should include clinical findings such as the presence of plaque, gingival inflammation, and bleeding on probing, along with a treatment plan that outlines oral hygiene instructions and any professional interventions.