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ICD-10 Guide
ICD-10 CodesK05.11

K05.11

Billable

Chronic gingivitis, non-plaque induced

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

Code Description

ICD-10 K05.11 is a billable code used to indicate a diagnosis of chronic gingivitis, non-plaque induced.

Key Diagnostic Point:

Chronic gingivitis, non-plaque induced, is characterized by inflammation of the gingival tissues that is not primarily caused by the accumulation of dental plaque. Clinically, patients may present with swollen, red gums that may bleed upon probing or brushing. The condition can affect any part of the gingiva, including the marginal and attached gingiva, and may lead to periodontal disease if left untreated. The anatomy involved includes the gingival tissues, which are critical for supporting the teeth and maintaining oral health. Disease progression can vary; while some patients may experience mild symptoms, others may develop more severe manifestations, including periodontal attachment loss. Diagnostic considerations include a thorough clinical examination, patient history, and possibly the exclusion of other causes of gingival inflammation, such as systemic diseases or medication side effects. Laboratory tests may be warranted in atypical cases to rule out underlying conditions contributing to the gingivitis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from plaque-induced gingivitis and other oral conditions.
  • Treatment complexity: Management may involve dental cleanings, patient education, and addressing underlying systemic issues.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to distinguish from other gingival diseases.

Audit Risk Factors

  • Common coding errors: Misclassification as plaque-induced gingivitis.
  • Documentation gaps: Incomplete patient history or lack of clinical findings.
  • Billing challenges: Potential denials 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

Periodontology

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic gingivitis, non-plaque induced, has significant clinical implications as it can lead to more severe periodontal diseases if not managed appropriately. The condition affects a notable portion of the population, particularly those with underlying systemic conditions. Understanding and addressing this condition can improve overall oral health outcomes, reduce healthcare utilization related to advanced periodontal disease, and enhance quality measures in dental care.

ICD-9 vs ICD-10

Chronic gingivitis, non-plaque induced, has significant clinical implications as it can lead to more severe periodontal diseases if not managed appropriately. The condition affects a notable portion of the population, particularly those with underlying systemic conditions. Understanding and addressing this condition can improve overall oral health outcomes, reduce healthcare utilization related to advanced periodontal disease, and enhance quality measures in dental care.

Reimbursement & Billing Impact

Reimbursement considerations may vary by payer, so it's essential to verify coverage policies. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include using clear, specific language in notes and ensuring that all relevant clinical findings are included.

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 K05.11?

K05.11 covers chronic gingivitis that is not primarily caused by plaque accumulation. This includes gingivitis related to systemic conditions, hormonal changes, or other non-plaque factors.

When should K05.11 be used instead of related codes?

K05.11 should be used when the gingivitis is clearly identified as non-plaque induced, especially when other factors such as systemic diseases or medications are involved.

What documentation supports K05.11?

Documentation should include a comprehensive clinical examination, patient history detailing any systemic conditions or medications, and evidence of gingival inflammation without significant plaque accumulation.