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ICD-10 Guide
ICD-10 CodesK06.8

K06.8

Billable

Other specified disorders of gingiva and edentulous alveolar ridge

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

Code Description

ICD-10 K06.8 is a billable code used to indicate a diagnosis of other specified disorders of gingiva and edentulous alveolar ridge.

Key Diagnostic Point:

K06.8 refers to other specified disorders of the gingiva and edentulous alveolar ridge, which are conditions affecting the soft tissues surrounding the teeth and the bony ridge that supports the teeth. Clinically, these disorders may present as inflammation, swelling, or other pathological changes in the gingiva, which can lead to discomfort, bleeding, and potential complications in oral health. The anatomy involved includes the gingival tissue, which is crucial for maintaining the integrity of the oral cavity and supporting the teeth. Disease progression can vary; mild cases may resolve with improved oral hygiene, while more severe cases could lead to periodontal disease or tooth loss if untreated. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of the disorder. It is essential to differentiate K06.8 from other gingival disorders, such as gingivitis (K05.1) or periodontitis (K05.3), to ensure appropriate management and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly imaging.
  • Treatment complexity: May involve non-surgical and surgical interventions.
  • Documentation requirements: Detailed clinical notes and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from similar conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other gingival disorders.
  • Documentation gaps: Incomplete clinical notes may lead to coding inaccuracies.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis.

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

Oral and Maxillofacial Surgery

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

The clinical significance of K06.8 lies in its potential to affect oral health and overall well-being. Disorders of the gingiva can lead to complications such as periodontal disease, which is linked to systemic health issues like cardiovascular disease and diabetes. Understanding the epidemiology of gingival disorders can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures related to oral health can improve healthcare utilization patterns and enhance patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K06.8 lies in its potential to affect oral health and overall well-being. Disorders of the gingiva can lead to complications such as periodontal disease, which is linked to systemic health issues like cardiovascular disease and diabetes. Understanding the epidemiology of gingival disorders can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures related to oral health can improve healthcare utilization patterns and enhance patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the services rendered are medically necessary and appropriately coded. Common denials may arise from insufficient documentation or incorrect coding, so it is crucial to maintain detailed records of clinical findings and treatment plans. Best practices include verifying insurance coverage for specific procedures related to gingival disorders and ensuring that all services are coded accurately to reflect the patient's condition.

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 K06.8?

K06.8 encompasses various gingival disorders not classified elsewhere, including atypical gingival hyperplasia, localized gingival recession, and other non-specific gingival lesions that do not fit into more defined categories.

When should K06.8 be used instead of related codes?

K06.8 should be used when the gingival disorder does not meet the criteria for more specific codes like K05.1 or K05.3, particularly when the condition is atypical or has unique characteristics that warrant separate classification.

What documentation supports K06.8?

Documentation should include a comprehensive clinical examination, detailed patient history, treatment plans, and any imaging studies that support the diagnosis of a specified disorder of the gingiva or edentulous alveolar ridge.