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ICD-10 Guide
ICD-10 CodesK08.403

K08.403

Billable

Partial loss of teeth, unspecified cause, class III

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

Code Description

ICD-10 K08.403 is a billable code used to indicate a diagnosis of partial loss of teeth, unspecified cause, class iii.

Key Diagnostic Point:

K08.403 refers to partial loss of teeth due to an unspecified cause, classified as Class III. This condition can significantly impact the digestive system, particularly the gastrointestinal tract, as teeth play a crucial role in the mechanical breakdown of food. The anatomy involved includes the dental structures, specifically the teeth and supporting tissues, which may be affected by various factors such as periodontal disease, trauma, or developmental anomalies. Disease progression can lead to further tooth loss, malocclusion, and difficulties in mastication, potentially resulting in nutritional deficiencies and gastrointestinal disorders due to inadequate food intake. Diagnostic considerations include a thorough dental examination, radiographic imaging, and patient history to determine the underlying cause of tooth loss. Clinicians should assess the patient's oral health status and any related gastrointestinal symptoms to provide a comprehensive treatment plan that may involve restorative dentistry or dietary modifications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation of dental and gastrointestinal health.
  • Treatment complexity: May involve multidisciplinary approaches including dentistry and nutrition.
  • Documentation requirements: Detailed records of dental assessments and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of tooth loss severity or cause.
  • Documentation gaps: Incomplete dental records or lack of supporting clinical evidence.
  • Billing challenges: Potential denials due to insufficient documentation of the condition's impact on overall health.

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: Gastroenterology

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

The clinical significance of K08.403 lies in its potential to affect not only oral health but also overall nutritional status and gastrointestinal function. Partial tooth loss can lead to difficulties in chewing, which may result in dietary restrictions and malnutrition. This condition can impact population health by increasing the risk of gastrointestinal disorders and necessitating additional healthcare resources. Quality measures may include monitoring the prevalence of dental issues and their correlation with gastrointestinal health, emphasizing the importance of integrated care approaches.

ICD-9 vs ICD-10

The clinical significance of K08.403 lies in its potential to affect not only oral health but also overall nutritional status and gastrointestinal function. Partial tooth loss can lead to difficulties in chewing, which may result in dietary restrictions and malnutrition. This condition can impact population health by increasing the risk of gastrointestinal disorders and necessitating additional healthcare resources. Quality measures may include monitoring the prevalence of dental issues and their correlation with gastrointestinal health, emphasizing the importance of integrated care approaches.

Reimbursement & Billing Impact

impact on their health. Reimbursement considerations include verifying coverage for dental procedures related to tooth loss and ensuring that claims are submitted with appropriate modifiers when necessary. Common denials may arise from insufficient documentation or failure to demonstrate the medical necessity of treatments. Best practices include maintaining clear and comprehensive records of dental evaluations, treatment plans, and any referrals to other specialties, such as gastroenterology, to support the overall management of the patient's health.

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 K08.403?

K08.403 covers partial loss of teeth due to various unspecified causes, including but not limited to periodontal disease, trauma, or congenital conditions. It does not specify the underlying etiology, making it essential for clinicians to document the patient's history and clinical findings.

When should K08.403 be used instead of related codes?

K08.403 should be used when there is partial loss of teeth without a specified cause. If the cause is known, such as trauma or disease, other specific codes should be selected to accurately reflect the patient's condition.

What documentation supports K08.403?

Documentation for K08.403 should include a comprehensive dental examination report, radiographic findings, and a detailed history of the patient's oral health. Any related gastrointestinal symptoms or dietary impacts should also be documented to support the diagnosis.