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ICD-10 Guide
ICD-10 CodesK08.491

K08.491

Billable

Partial loss of teeth due to other specified cause, class I

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

Code Description

ICD-10 K08.491 is a billable code used to indicate a diagnosis of partial loss of teeth due to other specified cause, class i.

Key Diagnostic Point:

K08.491 refers to partial loss of teeth due to other specified causes, class I. This condition can arise from various factors including trauma, dental caries, periodontal disease, or other systemic conditions that affect oral health. Clinically, patients may present with missing teeth, altered occlusion, and potential difficulties in mastication, which can lead to nutritional deficiencies and gastrointestinal complications. The anatomy involved primarily includes the dental structures such as enamel, dentin, and periodontal tissues. Disease progression may vary; for instance, untreated periodontal disease can lead to further tooth loss and systemic implications. Diagnostic considerations include a thorough dental examination, radiographic imaging, and possibly laboratory tests to rule out underlying systemic diseases. It is essential for healthcare providers to assess the patient's overall health and any contributing factors to the loss of teeth, as this can influence treatment options and outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification of the cause of tooth loss.
  • Documentation gaps may arise if the specific cause is not clearly stated.
  • Billing challenges can occur if the relationship between tooth loss and underlying conditions is not well documented.

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 K08.491 lies in its potential impact on a patient's overall health, particularly regarding nutrition and gastrointestinal function due to impaired mastication. Population health impact includes the prevalence of dental issues leading to tooth loss, which can affect quality of life and healthcare utilization patterns. Addressing these conditions through proper coding and treatment can improve health outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

The clinical significance of K08.491 lies in its potential impact on a patient's overall health, particularly regarding nutrition and gastrointestinal function due to impaired mastication. Population health impact includes the prevalence of dental issues leading to tooth loss, which can affect quality of life and healthcare utilization patterns. Addressing these conditions through proper coding and treatment can improve health outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is essential to follow specific guidelines for the documentation of the cause of tooth loss. Common denials may arise from insufficient documentation or failure to link the diagnosis to the treatment provided. Best practices include maintaining thorough records of patient assessments, treatment plans, and outcomes to support the coding and billing process.

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 K08.491?

K08.491 covers partial loss of teeth due to specified causes such as trauma, systemic diseases (e.g., diabetes), or other dental conditions that do not fall under more specific codes. It is essential to document the exact cause for accurate coding.

When should K08.491 be used instead of related codes?

K08.491 should be used when there is a clear identification of the cause of tooth loss that is not classified under other specific codes. If the cause is unspecified, K08.49 may be more appropriate.

What documentation supports K08.491?

Documentation should include a detailed patient history, clinical findings, radiographic evidence, and any relevant laboratory results that support the diagnosis of partial tooth loss due to specified causes.