ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesK06.1

K06.1

Billable

Gingival enlargement

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

Code Description

ICD-10 K06.1 is a billable code used to indicate a diagnosis of gingival enlargement.

Key Diagnostic Point:

Gingival enlargement, also known as gingival hyperplasia, is characterized by an abnormal increase in the size of the gingiva (gums) due to an increase in the number of cells. This condition can be localized or generalized and may be associated with various factors, including medications (such as anticonvulsants and calcium channel blockers), systemic diseases (like diabetes and hormonal changes), and poor oral hygiene. Clinically, patients may present with swollen, red, and tender gums that may bleed easily. The anatomy involved primarily includes the gingival tissue, which is the mucosal tissue surrounding the teeth. Disease progression can lead to periodontal disease if not managed properly, resulting in tooth mobility and loss. Diagnostic considerations include a thorough medical history, medication review, and clinical examination, often supplemented by dental radiographs to assess periodontal health. Differential diagnoses may include other forms of gingivitis or periodontal disease, necessitating careful evaluation to determine the underlying cause.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of various etiologies and potential systemic connections.
  • Treatment complexity: Management may involve dental hygiene improvement, medication adjustments, or surgical intervention.
  • Documentation requirements: Detailed clinical notes and history are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other gingival conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of gingival enlargement as simple gingivitis.
  • Documentation gaps: Incomplete patient history or lack of medication review.
  • Billing challenges: Potential denials if the underlying cause is not well documented.

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: 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Gingival enlargement can significantly affect oral health, leading to complications such as periodontal disease and tooth loss. Its prevalence can vary based on population demographics, with certain groups being more susceptible due to medication use or systemic conditions. Understanding and managing this condition is crucial for improving overall oral health outcomes and reducing healthcare utilization related to dental complications.

ICD-9 vs ICD-10

Gingival enlargement can significantly affect oral health, leading to complications such as periodontal disease and tooth loss. Its prevalence can vary based on population demographics, with certain groups being more susceptible due to medication use or systemic conditions. Understanding and managing this condition is crucial for improving overall oral health outcomes and reducing healthcare utilization related to dental complications.

Reimbursement & Billing Impact

Reimbursement may vary based on the underlying cause and associated treatments. Common denials can occur if the documentation does not clearly support the diagnosis or if the treatment provided is not adequately justified. Best practices include ensuring that all clinical notes are thorough and that any medications contributing to the condition are clearly noted in the patient's record.

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 K06.1?

K06.1 covers gingival enlargement due to various causes, including drug-induced hyperplasia, systemic diseases, and hormonal changes. It is essential to document the specific etiology to ensure accurate coding.

When should K06.1 be used instead of related codes?

K06.1 should be used when there is a clear diagnosis of gingival enlargement, particularly when it is not solely due to inflammation or other gingival conditions. Differentiation from K06.0 (Gingivitis) is crucial.

What documentation supports K06.1?

Documentation should include a comprehensive medical history, details of any medications that may contribute to the condition, clinical examination findings, and any relevant diagnostic tests performed.