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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK02

K02

Non-billable

Dental caries

Chapter 11:Diseases of the digestive system

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

Code Description

ICD-10 K02 is a used to indicate a diagnosis of dental caries.

Key Diagnostic Point:

Dental caries, commonly known as tooth decay or cavities, is a localized destruction of the hard tissues of the teeth caused by the acidic byproducts of bacterial fermentation of dietary carbohydrates. The condition primarily affects the enamel, dentin, and cementum of the teeth. Clinically, dental caries may present as white spots on the enamel, which can progress to brown or black lesions as the decay advances. The disease progression can lead to pain, infection, and even tooth loss if left untreated. The anatomy involved includes the teeth, which are composed of enamel, dentin, and pulp. Diagnosis is typically made through clinical examination and radiographic imaging, which can reveal the extent of decay. Early detection is crucial for effective management, which may include fluoride treatments, fillings, or more extensive restorative procedures depending on the severity of the caries. Regular dental check-ups and good oral hygiene practices are essential for prevention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors include misclassification of the severity of caries.
  • Documentation gaps may arise from insufficient detail on the extent of decay.
  • Billing challenges often occur due to the need for precise coding to reflect the treatment provided.

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

General practice

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 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

Dental caries significantly impacts population health, contributing to increased healthcare utilization and costs associated with dental treatments. It is a prevalent condition affecting individuals of all ages, with higher incidence rates in children and adolescents. Quality measures often focus on preventive care and early intervention strategies to reduce the prevalence of caries, thereby improving overall oral health outcomes and reducing the burden on healthcare systems.

ICD-9 vs ICD-10

Dental caries significantly impacts population health, contributing to increased healthcare utilization and costs associated with dental treatments. It is a prevalent condition affecting individuals of all ages, with higher incidence rates in children and adolescents. Quality measures often focus on preventive care and early intervention strategies to reduce the prevalence of caries, thereby improving overall oral health outcomes and reducing the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of detailed records that justify the services rendered. Common denials may arise from lack of specificity in the diagnosis or insufficient documentation of treatment. Best practices include using precise coding, maintaining thorough patient records, and ensuring that all services are supported by clinical evidence to facilitate smooth billing processes.

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 K02?

K02 covers various forms of dental caries, including smooth surface caries, pit and fissure caries, and secondary caries that occur around existing restorations. It does not cover caries associated with systemic diseases or conditions.

When should K02 be used instead of related codes?

K02 should be used when the diagnosis specifically pertains to dental caries without complications. If the condition involves pulpitis or abscess formation, other codes such as K04 should be considered.

What documentation supports K02?

Documentation should include clinical findings from examinations, radiographic evidence of caries, treatment plans, and notes on patient history related to oral hygiene and dietary habits.