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ICD-10 Guide
ICD-10 CodesK02.61

K02.61

Billable

Dental caries on smooth surface limited to enamel

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

Code Description

ICD-10 K02.61 is a billable code used to indicate a diagnosis of dental caries on smooth surface limited to enamel.

Key Diagnostic Point:

Dental caries on smooth surfaces limited to enamel is a localized dental condition characterized by the demineralization of enamel due to the action of acids produced by bacteria in the oral cavity. Clinically, it presents as white spots or lesions on the smooth surfaces of teeth, which may progress to cavitation if not treated. The anatomy involved primarily includes the enamel, which is the outermost layer of the tooth, and the underlying dentin may become affected if the caries advances. Disease progression typically starts with the initial demineralization of enamel, leading to visible lesions, and if untreated, can result in deeper decay affecting the dentin and pulp. Diagnostic considerations include visual examination, radiographic assessment, and the use of diagnostic tools to evaluate the extent of caries. Early detection and intervention are crucial to prevent further deterioration and maintain oral health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical examination and possibly radiographs for accurate assessment.
  • Treatment complexity: Treatment may involve preventive measures, restorative procedures, or referrals to specialists.
  • Documentation requirements: Detailed documentation of clinical findings, treatment plans, and patient education is essential.
  • Coding specificity: Requires precise coding to differentiate from other types of dental caries.

Audit Risk Factors

  • Common coding errors: Misclassification of caries type or surface.
  • Documentation gaps: Incomplete records of clinical findings or treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the level of care 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

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 K02.61 lies in its potential to lead to more severe dental issues if not addressed promptly. Population health impact includes the prevalence of dental caries as a common condition affecting oral health, which can influence overall health outcomes. Quality measures may focus on preventive care and early intervention strategies to reduce the incidence of dental caries. Understanding healthcare utilization patterns related to dental care can help in developing effective public health initiatives aimed at improving oral health literacy and access to preventive services.

ICD-9 vs ICD-10

The clinical significance of K02.61 lies in its potential to lead to more severe dental issues if not addressed promptly. Population health impact includes the prevalence of dental caries as a common condition affecting oral health, which can influence overall health outcomes. Quality measures may focus on preventive care and early intervention strategies to reduce the incidence of dental caries. Understanding healthcare utilization patterns related to dental care can help in developing effective public health initiatives aimed at improving oral health literacy and access to preventive services.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear justification of the services rendered, particularly if restorative procedures are performed. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining thorough records of patient assessments, treatment plans, and follow-up care to support claims and reduce the risk of audits.

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 K02.61?

K02.61 specifically covers dental caries that are limited to the enamel on smooth surfaces of teeth. It does not include caries affecting pits, fissures, or dentin.

When should K02.61 be used instead of related codes?

K02.61 should be used when the caries is confirmed to be on smooth surfaces and limited to enamel. If the caries has progressed to dentin or involves other surfaces, different codes should be selected.

What documentation supports K02.61?

Documentation should include clinical findings from examinations, radiographic evidence if applicable, treatment plans, and patient education regarding oral hygiene and preventive measures.