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ICD-10 Guide
ICD-10 CodesK08.431

K08.431

Billable

Partial loss of teeth due to caries, class I

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

Code Description

ICD-10 K08.431 is a billable code used to indicate a diagnosis of partial loss of teeth due to caries, class i.

Key Diagnostic Point:

K08.431 refers to partial loss of teeth due to caries, class I, which is characterized by the loss of dental structure primarily affecting the enamel and dentin layers of the teeth. This condition often presents with visible decay, sensitivity to temperature changes, and potential pain during chewing. The anatomy involved includes the teeth, specifically the crown and root structures, which are essential for mastication and overall oral health. Disease progression typically begins with the demineralization of enamel, advancing to deeper layers if untreated, potentially leading to tooth loss. Diagnostic considerations include clinical examination, radiographic evaluation, and patient history to assess the extent of caries and any associated symptoms. Early intervention is crucial to prevent further deterioration and maintain oral function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical assessment and imaging to determine extent of caries.
  • Treatment complexity: May involve restorative procedures such as fillings or crowns.
  • Documentation requirements: Detailed records of clinical findings and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental caries classifications.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity of caries.
  • Documentation gaps: Incomplete records of clinical findings or treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the severity of the condition.

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 K08.431 lies in its potential to affect oral health and overall well-being. Partial loss of teeth can lead to difficulties in chewing, impacting nutrition and quality of life. Population health impact includes the prevalence of dental caries, which remains a significant public health concern. Quality measures focus on preventive care and early intervention to reduce the incidence of caries and associated complications, ultimately influencing healthcare utilization patterns.

ICD-9 vs ICD-10

The clinical significance of K08.431 lies in its potential to affect oral health and overall well-being. Partial loss of teeth can lead to difficulties in chewing, impacting nutrition and quality of life. Population health impact includes the prevalence of dental caries, which remains a significant public health concern. Quality measures focus on preventive care and early intervention to reduce the incidence of caries and associated complications, ultimately influencing healthcare utilization patterns.

Reimbursement & Billing Impact

reimbursement and reduce the risk of audits.

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 K08.431?

K08.431 specifically covers partial loss of teeth due to caries classified as class I, which indicates early-stage decay affecting enamel and dentin without pulp involvement.

When should K08.431 be used instead of related codes?

K08.431 should be used when there is partial loss of tooth structure due to caries that has not progressed to more severe stages, differentiating it from codes indicating complete loss or more advanced decay.

What documentation supports K08.431?

Documentation should include clinical notes detailing the examination findings, radiographic evidence of caries, treatment plans, and any patient-reported symptoms related to the affected teeth.