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ICD-10 Guide
ICD-10 CodesK06.012

K06.012

Billable

Localized gingival recession, moderate

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

Code Description

ICD-10 K06.012 is a billable code used to indicate a diagnosis of localized gingival recession, moderate.

Key Diagnostic Point:

Localized gingival recession, moderate, refers to the apical migration of the gingival margin, resulting in exposure of the root surface of the tooth. This condition is characterized by a moderate degree of recession, typically defined as 3-4 mm of gingival tissue loss. Clinically, patients may present with sensitivity to temperature changes, aesthetic concerns, and potential for root caries. The anatomy involved includes the gingiva, periodontal ligament, and alveolar bone. Disease progression can be influenced by factors such as periodontal disease, mechanical trauma from brushing, and anatomical predispositions. Diagnostic considerations include clinical examination, probing depth measurements, and radiographic evaluation to assess the extent of periodontal attachment loss. Early identification and intervention are crucial to prevent further recession and associated complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and understanding of periodontal health.
  • Treatment complexity: Moderate, involving potential surgical and non-surgical interventions.
  • Documentation requirements: Requires detailed clinical notes and treatment plans.
  • Coding specificity: Specific to localized gingival recession, necessitating accurate coding to reflect the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity of gingival recession.
  • Documentation gaps: Incomplete clinical notes regarding the extent of recession.
  • Billing challenges: Potential denials if documentation does not support the severity and treatment provided.

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

Localized gingival recession has significant clinical implications, affecting oral health and aesthetics. It can lead to increased sensitivity, root caries, and potential tooth loss if untreated. The condition is prevalent in various populations, particularly among those with periodontal disease. Understanding the epidemiology of gingival recession can inform preventive measures and treatment strategies, ultimately improving patient outcomes and reducing healthcare utilization.

ICD-9 vs ICD-10

Localized gingival recession has significant clinical implications, affecting oral health and aesthetics. It can lead to increased sensitivity, root caries, and potential tooth loss if untreated. The condition is prevalent in various populations, particularly among those with periodontal disease. Understanding the epidemiology of gingival recession can inform preventive measures and treatment strategies, ultimately improving patient outcomes and reducing healthcare utilization.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of procedures performed, such as scaling and root planing or surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include thorough clinical notes, clear treatment plans, and ensuring that all services rendered are appropriately linked to the diagnosis code.

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 K06.012?

K06.012 specifically covers moderate localized gingival recession, which may occur due to periodontal disease, trauma, or anatomical factors. It is important to differentiate this from mild or severe cases, as treatment approaches may vary.

When should K06.012 be used instead of related codes?

K06.012 should be used when there is a documented moderate level of gingival recession. If the recession is classified as mild (K06.011) or severe (K06.013), those specific codes should be utilized instead.

What documentation supports K06.012?

Documentation should include clinical examination findings, probing depths, extent of recession, and any treatment plans. Photographic evidence may also be beneficial to illustrate the condition.