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ICD-10 Guide
ICD-10 CodesK08.54

K08.54

Billable

Contour of existing restoration of tooth biologically incompatible with oral health

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

Code Description

ICD-10 K08.54 is a billable code used to indicate a diagnosis of contour of existing restoration of tooth biologically incompatible with oral health.

Key Diagnostic Point:

K08.54 refers to the contour of an existing dental restoration that is biologically incompatible with oral health. This condition typically arises when dental materials used in restorations, such as fillings or crowns, provoke adverse reactions in the oral environment. Clinically, patients may present with symptoms such as localized inflammation, pain, or discomfort in the affected tooth or surrounding tissues. The anatomy involved primarily includes the tooth structure, surrounding gingiva, and supporting alveolar bone. Disease progression can lead to further complications, including secondary caries, periodontal disease, or even tooth loss if not addressed. Diagnostic considerations include a thorough clinical examination, radiographic evaluation, and possibly allergy testing to identify the specific materials causing the incompatibility. It is crucial for dental professionals to assess the restoration's material composition and the patient's response to ensure appropriate management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of dental materials and patient-specific reactions.
  • Treatment complexity: May involve removal and replacement of restorations, requiring careful selection of biocompatible materials.
  • Documentation requirements: Detailed records of patient history, symptoms, and treatment plans are essential.
  • Coding specificity: Requires accurate identification of the specific restoration and its incompatibility.

Audit Risk Factors

  • Common coding errors: Misidentification of the restoration type or failure to document the incompatibility.
  • Documentation gaps: Incomplete patient history or lack of evidence for the incompatibility claim.
  • Billing challenges: Potential denials if the incompatibility is not clearly documented or justified.

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 K08.54 lies in its potential to prevent further oral health complications and improve patient outcomes. Biologically incompatible restorations can lead to chronic pain, infection, and loss of teeth, impacting overall quality of life. Understanding and addressing this condition can enhance population health by reducing the incidence of dental complications and improving healthcare utilization patterns. Awareness of this issue also contributes to better quality measures in dental care, ensuring that patients receive safe and effective treatments.

ICD-9 vs ICD-10

The clinical significance of K08.54 lies in its potential to prevent further oral health complications and improve patient outcomes. Biologically incompatible restorations can lead to chronic pain, infection, and loss of teeth, impacting overall quality of life. Understanding and addressing this condition can enhance population health by reducing the incidence of dental complications and improving healthcare utilization patterns. Awareness of this issue also contributes to better quality measures in dental care, ensuring that patients receive safe and effective treatments.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on insurance policies, so it is crucial to verify coverage for specific dental materials and procedures. Common denials may occur if the documentation does not sufficiently demonstrate the incompatibility or if the procedure is not deemed medically necessary. Adhering to coding best practices, including accurate coding and thorough documentation, can help mitigate these challenges.

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 K08.54?

K08.54 covers conditions where existing dental restorations are made from materials that are biologically incompatible with the patient's oral health, leading to adverse reactions such as inflammation or pain.

When should K08.54 be used instead of related codes?

K08.54 should be used when there is clear evidence of incompatibility of the restoration material with the patient's oral health, differentiating it from codes that cover general complications without specifying material issues.

What documentation supports K08.54?

Documentation should include a detailed clinical assessment, patient history regarding previous restorations, symptoms experienced, and any diagnostic tests performed to confirm material incompatibility.