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ICD-10 Guide
ICD-10 CodesK08.499

K08.499

Billable

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

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

Code Description

ICD-10 K08.499 is a billable code used to indicate a diagnosis of partial loss of teeth due to other specified cause, unspecified class.

Key Diagnostic Point:

K08.499 refers to partial loss of teeth due to other specified causes, unspecified class. This condition can arise from various etiologies, including trauma, periodontal disease, or systemic conditions that affect oral health. Clinically, patients may present with difficulty chewing, aesthetic concerns, and potential impacts on speech. The anatomy involved primarily includes the teeth, gums, and supporting structures of the oral cavity. Disease progression can vary; for instance, periodontal disease may lead to gradual tooth loss, while trauma can result in sudden loss. Diagnostic considerations include a thorough dental examination, radiographic imaging to assess bone loss, and evaluation of the patient's medical history to identify underlying causes. Understanding the specific cause of tooth loss is crucial for appropriate management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of various underlying conditions.
  • Treatment complexity: May involve multidisciplinary approaches including dentistry and possibly other specialties.
  • Documentation requirements: Detailed documentation of the cause and extent of tooth loss is necessary.
  • Coding specificity: Requires precise coding to differentiate from other tooth loss codes.

Audit Risk Factors

  • Common coding errors: Misidentifying the cause of tooth loss.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis.

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: 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K08.499 lies in its association with broader health issues, as partial tooth loss can affect nutrition, speech, and overall quality of life. Population health impact includes increased healthcare utilization for dental services and potential links to systemic health conditions. Quality measures may focus on preventive care and management of oral health, emphasizing the importance of addressing tooth loss in the context of comprehensive patient care.

ICD-9 vs ICD-10

The clinical significance of K08.499 lies in its association with broader health issues, as partial tooth loss can affect nutrition, speech, and overall quality of life. Population health impact includes increased healthcare utilization for dental services and potential links to systemic health conditions. Quality measures may focus on preventive care and management of oral health, emphasizing the importance of addressing tooth loss in the context of comprehensive patient care.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for dental services related to tooth loss. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical notes, imaging reports, and treatment plans are included in the billing submission to support the claim and mitigate audit risks.

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 K08.499?

K08.499 encompasses partial tooth loss due to various specified causes, such as systemic diseases (e.g., diabetes, autoimmune disorders), trauma, or other dental conditions that do not fall under more specific codes. It is essential to document the underlying cause for accurate coding.

When should K08.499 be used instead of related codes?

K08.499 should be used when the cause of partial tooth loss is known but does not fit into the more specific categories provided by other codes. It is particularly relevant when the cause is multifactorial or not explicitly defined.

What documentation supports K08.499?

Documentation should include a comprehensive dental examination, radiographic findings, and a detailed medical history that outlines the patient's overall health and any contributing factors to tooth loss. This information is critical for substantiating the diagnosis.