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ICD-10 Guide
ICD-10 CodesK05.6

K05.6

Billable

Periodontal disease, unspecified

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

Code Description

ICD-10 K05.6 is a billable code used to indicate a diagnosis of periodontal disease, unspecified.

Key Diagnostic Point:

Periodontal disease, unspecified, refers to a group of inflammatory conditions affecting the supporting structures of the teeth, including the gums, periodontal ligament, and alveolar bone. Clinically, it presents with symptoms such as gum inflammation, bleeding during brushing, and potential tooth mobility. The disease can progress from gingivitis, characterized by reversible inflammation of the gums, to more severe forms like periodontitis, which can lead to tooth loss if untreated. The anatomy involved primarily includes the gingiva, periodontal ligaments, and surrounding bone structures. Diagnostic considerations involve clinical examination, probing depths, and radiographic evaluation to assess bone loss. The unspecified nature of K05.6 indicates that the specific type or severity of periodontal disease has not been determined, necessitating further evaluation for accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and possibly imaging.
  • Treatment complexity: May involve non-surgical and surgical interventions depending on severity.
  • Documentation requirements: Detailed documentation of clinical findings and treatment plans is essential.
  • Coding specificity: Unspecified code may lead to ambiguity in treatment and reimbursement.

Audit Risk Factors

  • Common coding errors: Misuse of unspecified codes when specific conditions are documented.
  • Documentation gaps: Incomplete records that do not support the diagnosis or treatment provided.
  • Billing challenges: Potential denials due to lack of specificity in coding.

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: Periodontics

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 disease has significant clinical implications, affecting not only oral health but also overall systemic health, as it has been linked to conditions such as cardiovascular disease and diabetes. The prevalence of periodontal disease in the population underscores the need for effective preventive measures and treatment strategies. Quality measures related to periodontal health are increasingly being integrated into healthcare utilization patterns, emphasizing the importance of early diagnosis and management to improve patient outcomes and reduce healthcare costs.

ICD-9 vs ICD-10

Periodontal disease has significant clinical implications, affecting not only oral health but also overall systemic health, as it has been linked to conditions such as cardiovascular disease and diabetes. The prevalence of periodontal disease in the population underscores the need for effective preventive measures and treatment strategies. Quality measures related to periodontal health are increasingly being integrated into healthcare utilization patterns, emphasizing the importance of early diagnosis and management to improve patient outcomes and reduce healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is crucial to include detailed notes on the clinical findings and treatment provided. Common denials may arise from insufficient documentation or the use of unspecified codes when more specific codes are warranted. Best practices include thorough documentation of the patient's periodontal status and treatment plan, as well as regular updates to coding practices based on payer guidelines.

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 K05.6?

K05.6 encompasses unspecified periodontal diseases, which may include various forms of gingivitis and periodontitis that have not been further classified. It is important to note that this code does not specify the severity or type of periodontal disease, which may require additional codes for more precise documentation.

When should K05.6 be used instead of related codes?

K05.6 should be used when the specific type of periodontal disease is not determined or documented. If the clinician can specify the type of periodontal disease, such as localized or generalized periodontitis, then the corresponding specific codes should be utilized.

What documentation supports K05.6?

Documentation supporting K05.6 should include clinical findings such as probing depths, bleeding on probing, and any radiographic evidence of bone loss. A comprehensive treatment plan and follow-up assessments are also crucial for substantiating the diagnosis.