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ICD-10 Guide
ICD-10 CodesK08.59

K08.59

Billable

Other unsatisfactory restoration of tooth

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

Code Description

ICD-10 K08.59 is a billable code used to indicate a diagnosis of other unsatisfactory restoration of tooth.

Key Diagnostic Point:

K08.59 refers to 'Other unsatisfactory restoration of tooth,' which encompasses various clinical scenarios where dental restorations fail to meet expected outcomes. This may include restorations that are improperly placed, have inadequate retention, or exhibit marginal discrepancies leading to secondary caries or periodontal issues. The anatomy involved primarily includes the tooth structure, including enamel, dentin, and pulp, as well as surrounding periodontal tissues. Disease progression can vary; if not addressed, unsatisfactory restorations can lead to further decay, tooth loss, or the need for more extensive dental procedures. Diagnostic considerations involve clinical examination, radiographic evaluation, and patient history to assess the restoration's integrity and the health of the surrounding tissues. Clinicians must evaluate the reasons for the unsatisfactory outcome, which may include material failure, improper technique, or patient factors such as bruxism or poor oral hygiene.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 K08.59 lies in its potential to prevent further dental complications and improve patient outcomes. Unsatisfactory restorations can lead to increased healthcare utilization, including additional dental visits and treatments. Understanding the epidemiology of dental restoration failures can inform quality measures and enhance population health initiatives aimed at improving oral health and reducing the incidence of dental diseases.

ICD-9 vs ICD-10

The clinical significance of K08.59 lies in its potential to prevent further dental complications and improve patient outcomes. Unsatisfactory restorations can lead to increased healthcare utilization, including additional dental visits and treatments. Understanding the epidemiology of dental restoration failures can inform quality measures and enhance population health initiatives aimed at improving oral health and reducing the incidence of dental diseases.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and common denials often stem from insufficient documentation or lack of medical necessity. Coders should ensure that all related procedures are accurately coded and linked to the diagnosis to avoid billing 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 K08.59?

K08.59 covers conditions such as failed crowns, bridges, fillings, or other restorations that do not function as intended, leading to complications like recurrent decay or periodontal disease.

When should K08.59 be used instead of related codes?

K08.59 should be used when the restoration is deemed unsatisfactory due to factors not covered by more specific codes, such as material failure or improper placement, which are not adequately described by codes like K08.5.

What documentation supports K08.59?

Documentation should include clinical notes detailing the examination findings, radiographic evidence of restoration failure, treatment history, and any patient-reported symptoms that indicate issues with the restoration.