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ICD-10 Guide
ICD-10 CodesK06.013

K06.013

Billable

Localized gingival recession, severe

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

Code Description

ICD-10 K06.013 is a billable code used to indicate a diagnosis of localized gingival recession, severe.

Key Diagnostic Point:

Localized gingival recession, severe, is characterized by the apical displacement of the gingival margin, resulting in exposure of the root surface of the teeth. This condition can lead to increased sensitivity, aesthetic concerns, and a higher risk of root caries. The anatomy involved includes the gingiva, periodontal ligament, and underlying alveolar bone. Disease progression may be influenced by factors such as periodontal disease, mechanical trauma from brushing, or anatomical predispositions. Clinically, patients may present with visible recession, sensitivity to temperature changes, and potential mobility of affected teeth. Diagnostic considerations include a thorough periodontal examination, probing depths, and radiographic evaluation to assess the extent of periodontal attachment loss. Treatment options may vary from non-surgical approaches, such as scaling and root planing, to surgical interventions like gingival grafting, depending on the severity and extent of the recession.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough periodontal assessment and understanding of gingival anatomy.
  • Treatment complexity: May involve multiple treatment modalities, including surgical options.
  • Documentation requirements: Detailed documentation of clinical findings and treatment plans is necessary.
  • Coding specificity: Requires precise coding to differentiate from other periodontal conditions.

Audit Risk Factors

  • Common coding errors: Misapplication of codes for less severe gingival recession.
  • Documentation gaps: Incomplete records of clinical findings and treatment rationale.
  • Billing challenges: Potential denials due to lack of supporting documentation for severity.

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, particularly in its severe form, can significantly impact oral health and quality of life. It affects not only individual patients but also broader population health, as untreated cases may lead to more severe periodontal disease and tooth loss. Quality measures related to periodontal health and preventive care are essential in managing this condition. Understanding epidemiological patterns can help healthcare providers identify at-risk populations and implement preventive strategies effectively.

ICD-9 vs ICD-10

Localized gingival recession, particularly in its severe form, can significantly impact oral health and quality of life. It affects not only individual patients but also broader population health, as untreated cases may lead to more severe periodontal disease and tooth loss. Quality measures related to periodontal health and preventive care are essential in managing this condition. Understanding epidemiological patterns can help healthcare providers identify at-risk populations and implement preventive strategies effectively.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of the treatment provided. Common denials may arise from insufficient documentation or incorrect coding. It is essential to ensure that all clinical notes, treatment rationale, and patient consent forms are complete and accurate to support the billing process. Familiarity with payer-specific guidelines can also enhance the likelihood of successful reimbursement.

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 K06.013?

K06.013 specifically covers severe localized gingival recession, which may be associated with periodontal disease, trauma, or anatomical factors leading to significant root exposure.

When should K06.013 be used instead of related codes?

K06.013 should be used when there is clear evidence of severe localized gingival recession, as indicated by clinical examination and probing depths, differentiating it from moderate or generalized conditions.

What documentation supports K06.013?

Documentation should include clinical examination findings, probing depths, photographs of the recession, treatment plans, and any relevant patient history that supports the diagnosis of severe localized gingival recession.