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ICD-10 Guide
ICD-10 CodesK05.5

K05.5

Billable

Other periodontal diseases

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

Code Description

ICD-10 K05.5 is a billable code used to indicate a diagnosis of other periodontal diseases.

Key Diagnostic Point:

K05.5 refers to other periodontal diseases, which encompass a variety of inflammatory conditions affecting the supporting structures of the teeth, including the gums, periodontal ligaments, and alveolar bone. Clinically, these diseases can present with symptoms such as gum inflammation, bleeding during brushing, and varying degrees of tooth mobility. The anatomy involved primarily includes the gingiva, periodontal ligament, and the alveolar bone that supports the teeth. Disease progression can vary; it may start as gingivitis, which is reversible, but can progress to more severe forms of periodontal disease, leading to tooth loss if not managed appropriately. Diagnostic considerations include clinical examination, probing depths, radiographic evaluation, and assessment of attachment loss. It is essential to differentiate between various periodontal diseases, as treatment approaches may differ significantly based on the specific condition diagnosed.

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

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

Periodontal diseases significantly impact population health, contributing to systemic conditions such as cardiovascular disease and diabetes. Effective management of periodontal health can improve overall health outcomes and reduce healthcare utilization. Quality measures related to oral health are increasingly being integrated into broader healthcare initiatives, emphasizing the importance of periodontal disease management in public health strategies.

ICD-9 vs ICD-10

Periodontal diseases significantly impact population health, contributing to systemic conditions such as cardiovascular disease and diabetes. Effective management of periodontal health can improve overall health outcomes and reduce healthcare utilization. Quality measures related to oral health are increasingly being integrated into broader healthcare initiatives, emphasizing the importance of periodontal disease management in public health strategies.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for periodontal treatments, as some plans may have specific criteria for coverage. Common denials may arise from insufficient documentation or incorrect coding. Best practices include thorough documentation of clinical findings, treatment plans, 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 K05.5?

K05.5 includes various periodontal diseases that do not fall under specific categories like chronic or aggressive periodontitis. This may include conditions such as necrotizing periodontal diseases, periodontal abscesses, and other less common forms of periodontal inflammation.

When should K05.5 be used instead of related codes?

K05.5 should be used when the periodontal disease does not fit the criteria for more specific codes like K05.3 or K05.4. It is important to document the clinical findings that support the use of this code to ensure accurate coding.

What documentation supports K05.5?

Documentation should include clinical findings such as probing depths, attachment loss measurements, radiographic evidence of bone loss, and a detailed history of the patient's periodontal health to support the diagnosis of other periodontal diseases.