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ICD-10 Guide
ICD-10 CodesK08.55

K08.55

Billable

Allergy to existing dental restorative material

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

Code Description

ICD-10 K08.55 is a billable code used to indicate a diagnosis of allergy to existing dental restorative material.

Key Diagnostic Point:

K08.55 refers to an allergy to existing dental restorative material, which can manifest as localized or systemic reactions following dental procedures involving materials such as amalgam, composite resins, or other restorative agents. Clinically, patients may present with symptoms such as oral mucosal lesions, swelling, itching, or even anaphylaxis in severe cases. The anatomy involved primarily includes the oral cavity, particularly the gingiva, mucosa, and underlying tissues. Disease progression can vary; some patients may experience immediate reactions, while others may develop delayed hypersensitivity over time. Diagnostic considerations include a thorough patient history, clinical examination, and possibly patch testing to identify specific allergens. It is crucial to differentiate between allergic reactions and other complications such as irritation or infection, which may mimic allergy symptoms. Accurate diagnosis is essential for effective management and to prevent future exposure to the offending material.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of symptoms and potential allergens.
  • Treatment complexity: Management may involve referral to an allergist or dentist for alternative materials.
  • Documentation requirements: Detailed patient history and symptom description are necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of allergic reactions as non-allergic conditions.
  • Documentation gaps: Incomplete patient history or lack of allergy testing results.
  • Billing challenges: Potential denials if the allergy is not well-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: Allergy and Immunology

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 K08.55 lies in its potential to affect patient safety and treatment outcomes. Allergies to dental materials can lead to complications that may require alternative treatment strategies, impacting overall healthcare utilization. Understanding the prevalence of such allergies can inform population health initiatives and improve quality measures in dental care. Epidemiologically, as dental materials evolve, ongoing monitoring of allergic reactions is essential to ensure patient safety and effective management.

ICD-9 vs ICD-10

The clinical significance of K08.55 lies in its potential to affect patient safety and treatment outcomes. Allergies to dental materials can lead to complications that may require alternative treatment strategies, impacting overall healthcare utilization. Understanding the prevalence of such allergies can inform population health initiatives and improve quality measures in dental care. Epidemiologically, as dental materials evolve, ongoing monitoring of allergic reactions is essential to ensure patient safety and effective management.

Reimbursement & Billing Impact

reimbursement.

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 K08.55?

K08.55 covers allergic reactions specifically related to dental restorative materials, including but not limited to reactions to amalgam, composite resins, and other dental materials that may cause hypersensitivity or allergic responses.

When should K08.55 be used instead of related codes?

K08.55 should be used when a patient has a confirmed allergy to dental restorative materials, as evidenced by clinical symptoms and diagnostic testing. It is distinct from other codes that may refer to non-allergic reactions or conditions unrelated to dental materials.

What documentation supports K08.55?

Documentation for K08.55 should include a detailed patient history of symptoms following dental procedures, results from allergy testing (if performed), and clinical notes that support the diagnosis of an allergy to specific dental materials.