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ICD-10 Guide
ICD-10 CodesK08.5

K08.5

Non-billable

Unsatisfactory restoration of tooth

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

Code Description

ICD-10 K08.5 is a used to indicate a diagnosis of unsatisfactory restoration of tooth.

Key Diagnostic Point:

K08.5 refers to unsatisfactory restoration of a tooth, which can occur when a dental restoration fails to meet the functional or aesthetic needs of the patient. Clinically, this may present as recurrent caries, fracture of the restoration, or patient dissatisfaction due to poor fit or color mismatch. The anatomy involved includes the tooth structure, surrounding gingival tissues, and the dental materials used for restoration. Disease progression can be influenced by factors such as oral hygiene, dietary habits, and the presence of underlying dental conditions. Diagnostic considerations include clinical examination, radiographic assessment, and patient-reported outcomes. Proper diagnosis is essential to determine whether the restoration needs repair, replacement, or further intervention. This code is particularly relevant in dental practices where restorations are common, and understanding the nuances of patient complaints is critical for effective treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation of restoration and patient history.
  • Treatment complexity: May involve multiple treatment options including repair or replacement.
  • Documentation requirements: Detailed records of patient complaints and clinical findings are necessary.
  • Coding specificity: Must differentiate between types of restorations and reasons for unsatisfactory outcomes.

Audit Risk Factors

  • Common coding errors: Misapplication of codes for routine restorations instead of unsatisfactory ones.
  • Documentation gaps: Incomplete records of patient complaints or treatment rationale.
  • Billing challenges: Potential for denials if documentation does not support the necessity of the procedure.

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

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 K08.5 lies in its potential to affect patient satisfaction and oral health outcomes. Unsatisfactory restorations can lead to increased healthcare utilization, including additional dental visits and procedures. Understanding the epidemiology of restoration failures can help providers improve treatment protocols and patient education, ultimately enhancing population health and quality measures in dental care.

ICD-9 vs ICD-10

The clinical significance of K08.5 lies in its potential to affect patient satisfaction and oral health outcomes. Unsatisfactory restorations can lead to increased healthcare utilization, including additional dental visits and procedures. Understanding the epidemiology of restoration failures can help providers improve treatment protocols and patient education, ultimately enhancing population health and quality measures in dental care.

Reimbursement & Billing Impact

The clinical significance of K08.5 lies in its potential to affect patient satisfaction and oral health outcomes. Unsatisfactory restorations can lead to increased healthcare utilization, including additional dental visits and procedures. Understanding the epidemiology of restoration failures can help providers improve treatment protocols and patient education, ultimately enhancing population health and quality measures in dental care.

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 K08.5?

K08.5 covers conditions where a dental restoration is deemed unsatisfactory due to factors such as inadequate fit, aesthetic issues, or functional failure. This includes crowns, fillings, and bridges that do not meet patient expectations or clinical standards.

When should K08.5 be used instead of related codes?

K08.5 should be used when the restoration has failed to perform as intended, leading to patient complaints or clinical findings that necessitate further intervention. It is important to differentiate this from codes for successful restorations or those requiring routine maintenance.

What documentation supports K08.5?

Documentation for K08.5 should include a detailed account of the patient's complaints, clinical examination findings, any diagnostic imaging results, and the rationale for determining the restoration as unsatisfactory. This ensures that the coding aligns with the clinical scenario.