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ICD-10 Guide
ICD-10 CodesK06.011

K06.011

Billable

Localized gingival recession, minimal

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

Code Description

ICD-10 K06.011 is a billable code used to indicate a diagnosis of localized gingival recession, minimal.

Key Diagnostic Point:

Localized gingival recession, minimal, refers to the condition where the gum tissue surrounding the teeth recedes, exposing the roots of the teeth. This condition often presents with minimal tissue loss and can be identified during routine dental examinations. The anatomy involved includes the gingiva, which is the soft tissue that surrounds and supports the teeth, and the underlying alveolar bone. Disease progression can vary; if left untreated, localized gingival recession may lead to increased sensitivity, root caries, and aesthetic concerns. Diagnostic considerations include a thorough clinical examination, periodontal probing, and possibly radiographic evaluation to assess the extent of recession and any associated bone loss. Clinicians should also consider the patient's oral hygiene practices, history of periodontal disease, and any contributing factors such as tobacco use or orthodontic treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and understanding of periodontal health.
  • Treatment complexity: May involve non-surgical interventions, patient education, and monitoring.
  • Documentation requirements: Detailed records of clinical findings and treatment plans are necessary.
  • Coding specificity: Accurate coding requires knowledge of gingival conditions and their classifications.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity of gingival recession.
  • Documentation gaps: Incomplete records of clinical findings or treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or treatment provided.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Localized gingival recession, while minimal, can have significant implications for oral health, leading to increased sensitivity and potential for caries if not managed. Understanding its prevalence in the population can inform preventive measures and improve patient education on oral hygiene practices. Quality measures may include tracking the incidence of gingival recession and the effectiveness of interventions, contributing to better overall periodontal health outcomes.

ICD-9 vs ICD-10

Localized gingival recession, while minimal, can have significant implications for oral health, leading to increased sensitivity and potential for caries if not managed. Understanding its prevalence in the population can inform preventive measures and improve patient education on oral hygiene practices. Quality measures may include tracking the incidence of gingival recession and the effectiveness of interventions, contributing to better overall periodontal health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear justification of the diagnosis and treatment plan. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining thorough records of patient assessments, treatment outcomes, 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 K06.011?

K06.011 specifically covers minimal localized gingival recession, which may be caused by factors such as aggressive tooth brushing, periodontal disease, or anatomical predispositions. It does not cover generalized recession or other periodontal diseases.

When should K06.011 be used instead of related codes?

K06.011 should be used when the gingival recession is localized and minimal, distinguishing it from more severe cases that may require K06.012 or K06.013. Accurate assessment of the recession's extent is crucial for proper code selection.

What documentation supports K06.011?

Documentation should include clinical findings from periodontal examinations, measurements of gingival recession, patient history, and any treatment plans. Photographic evidence may also support the diagnosis.