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ICD-10 Guide
ICD-10 CodesK08.530

K08.530

Billable

Fractured dental restorative material without loss of material

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

Code Description

ICD-10 K08.530 is a billable code used to indicate a diagnosis of fractured dental restorative material without loss of material.

Key Diagnostic Point:

K08.530 refers to fractured dental restorative material without loss of material, which typically involves the failure of dental restorations such as crowns, bridges, or fillings. Clinically, patients may present with symptoms such as discomfort, sensitivity, or aesthetic concerns, depending on the location and extent of the fracture. The anatomy involved primarily includes the teeth and surrounding structures, where restorative materials are applied to restore function and aesthetics. Disease progression can vary; while some fractures may be acute due to trauma or excessive force, others may develop over time due to wear and tear or poor oral hygiene. Diagnostic considerations include clinical examination, radiographic evaluation, and patient history to ascertain the cause of the fracture and to determine the appropriate treatment plan. It is essential to differentiate between fractures that involve loss of material and those that do not, as this impacts treatment options and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of dental materials and their failure mechanisms.
  • Treatment complexity: May involve simple repair or more complex restorative procedures.
  • Documentation requirements: Detailed documentation of the fracture and treatment plan is necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of fracture.
  • Documentation gaps: Incomplete records regarding the nature of the fracture.
  • Billing challenges: Potential denials if the documentation does not clearly support the diagnosis.

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 K08.530 lies in its implications for dental health and patient quality of life. Fractured restorations can lead to discomfort, further dental complications, and increased healthcare utilization. Understanding the epidemiology of dental restoration failures can help in developing preventive strategies and improving patient outcomes. Monitoring these cases contributes to quality measures in dental care, ultimately enhancing population health.

ICD-9 vs ICD-10

The clinical significance of K08.530 lies in its implications for dental health and patient quality of life. Fractured restorations can lead to discomfort, further dental complications, and increased healthcare utilization. Understanding the epidemiology of dental restoration failures can help in developing preventive strategies and improving patient outcomes. Monitoring these cases contributes to quality measures in dental care, ultimately enhancing population health.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the insurance provider, and it is essential to verify coverage for dental procedures. Common denials may arise from insufficient documentation or incorrect coding. Best practices include maintaining thorough clinical notes, ensuring accurate coding, and confirming that the treatment plan aligns with the documented diagnosis.

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 K08.530?

K08.530 covers fractures of dental restorative materials such as crowns, inlays, onlays, and fillings that do not result in loss of material. It is important to document the type of restorative material and the circumstances leading to the fracture.

When should K08.530 be used instead of related codes?

K08.530 should be used when a dental restoration is fractured but intact, meaning there is no loss of material. If there is loss of material, K08.531 should be considered instead.

What documentation supports K08.530?

Documentation should include clinical notes detailing the patient's symptoms, examination findings, and any imaging studies that confirm the fracture without loss of material. Treatment plans and progress notes are also essential.