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ICD-10 Guide
ICD-10 CodesK08.43

K08.43

Non-billable

Partial loss of teeth due to caries

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

Code Description

ICD-10 K08.43 is a used to indicate a diagnosis of partial loss of teeth due to caries.

Key Diagnostic Point:

K08.43 refers to partial loss of teeth due to caries, a condition characterized by the decay of tooth structure leading to the loss of one or more teeth. The clinical presentation may include visible cavities, sensitivity to temperature changes, and pain during chewing. The anatomy involved primarily includes the enamel, dentin, and pulp of the teeth, which can be progressively affected by carious lesions. Disease progression typically starts with demineralization of the enamel, advancing to dentin involvement, and potentially leading to pulpitis if untreated. Diagnostic considerations include clinical examination, radiographic evaluation, and patient history to assess the extent of caries and tooth loss. Early detection and intervention are crucial to prevent further deterioration and complications, such as infections or abscess formation, which can impact overall health and nutrition due to difficulties in mastication.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and imaging to determine extent of caries.
  • Treatment complexity: May involve restorative procedures, extractions, or prosthetic solutions.
  • Documentation requirements: Detailed records of clinical findings and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of the extent of tooth loss.
  • Documentation gaps: Insufficient clinical notes to support the diagnosis.
  • Billing challenges: Potential denials due to lack of clear treatment rationale.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K08.43 lies in its association with oral health and overall well-being. Partial loss of teeth can affect nutrition and quality of life, leading to broader public health implications. Understanding the epidemiology of dental caries and its impact on various populations can inform preventive measures and healthcare utilization patterns, emphasizing the need for regular dental check-ups and education on oral hygiene.

ICD-9 vs ICD-10

The clinical significance of K08.43 lies in its association with oral health and overall well-being. Partial loss of teeth can affect nutrition and quality of life, leading to broader public health implications. Understanding the epidemiology of dental caries and its impact on various populations can inform preventive measures and healthcare utilization patterns, emphasizing the need for regular dental check-ups and education on oral hygiene.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the treatment performed, such as restorative procedures or extractions. Common denials may arise from insufficient documentation or misclassification of the dental condition. Coders should ensure that all services rendered are clearly linked to the diagnosis, and that treatment plans are well-documented to support claims.

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 K08.43?

K08.43 specifically covers cases of partial tooth loss attributed to caries, including situations where one or more teeth are affected but not completely lost. It may also encompass cases where caries have led to significant structural compromise without complete loss.

When should K08.43 be used instead of related codes?

K08.43 should be used when there is clear documentation of partial tooth loss due to caries. It is important to differentiate it from codes indicating complete loss of teeth or other dental conditions, ensuring accurate representation of the patient's dental status.

What documentation supports K08.43?

Documentation should include clinical findings from examinations, radiographic evidence showing carious lesions, treatment plans, and notes on patient history regarding dental hygiene and previous interventions.