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ICD-10 Guide
ICD-10 CodesK05.3

K05.3

Non-billable

Chronic periodontitis

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

Code Description

ICD-10 K05.3 is a used to indicate a diagnosis of chronic periodontitis.

Key Diagnostic Point:

Chronic periodontitis is a common inflammatory disease affecting the supporting structures of the teeth, primarily the gums and bone. Clinically, it presents with symptoms such as gum inflammation, pocket formation, and loss of attachment, which can lead to tooth mobility and eventual tooth loss if left untreated. The disease is characterized by a slow, progressive course, often exacerbated by factors such as poor oral hygiene, smoking, and systemic conditions like diabetes. The anatomy involved includes the periodontal ligament, alveolar bone, and gingival tissues. Diagnosis typically involves clinical examination, probing depths, and radiographic evaluation to assess bone loss. Disease progression can vary significantly among individuals, with some experiencing rapid deterioration while others may remain stable for years. Regular dental check-ups and appropriate periodontal therapy are crucial for managing this condition effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and radiographic assessment.
  • Treatment complexity: Involves non-surgical and surgical interventions depending on severity.
  • Documentation requirements: Detailed records of clinical findings and treatment plans are necessary.
  • Coding specificity: Requires accurate coding based on the severity and extent of the disease.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity of periodontitis.
  • Documentation gaps: Incomplete records of treatment and patient compliance.
  • Billing challenges: Issues with insurance coverage for periodontal treatments.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic periodontitis significantly impacts population health, contributing to tooth loss and affecting overall quality of life. It is associated with systemic conditions such as cardiovascular disease and diabetes, highlighting its importance in healthcare utilization patterns. Effective management of chronic periodontitis can improve patient outcomes and reduce healthcare costs, making it a critical focus for preventive measures and quality improvement initiatives.

ICD-9 vs ICD-10

Chronic periodontitis significantly impacts population health, contributing to tooth loss and affecting overall quality of life. It is associated with systemic conditions such as cardiovascular disease and diabetes, highlighting its importance in healthcare utilization patterns. Effective management of chronic periodontitis can improve patient outcomes and reduce healthcare costs, making it a critical focus for preventive measures and quality improvement initiatives.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of demonstrating medical necessity for procedures performed, as well as compliance with insurance guidelines. Common denials may arise from insufficient documentation or failure to meet the criteria for periodontal disease severity. Best practices include maintaining thorough records of clinical findings, treatment progress, and patient compliance to support claims and reduce the risk of audits.

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 K05.3?

K05.3 specifically covers chronic periodontitis, which may include varying degrees of attachment loss and pocket depth. It does not cover acute forms of periodontitis or other periodontal diseases.

When should K05.3 be used instead of related codes?

K05.3 should be used when the patient exhibits chronic periodontitis with evidence of attachment loss and periodontal pockets, differentiating it from localized forms or other periodontal conditions.

What documentation supports K05.3?

Documentation should include clinical findings such as probing depths, attachment levels, radiographic evidence of bone loss, and treatment plans. Regular updates on patient progress are also essential.