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ICD-10 Guide
ICD-10 CodesK04.0

K04.0

Non-billable

Pulpitis

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

Code Description

ICD-10 K04.0 is a used to indicate a diagnosis of pulpitis.

Key Diagnostic Point:

Pulpitis is an inflammatory condition affecting the dental pulp, which is the innermost part of the tooth containing nerves and blood vessels. Clinically, pulpitis can present as acute or chronic, with symptoms ranging from mild discomfort to severe pain, often exacerbated by thermal stimuli or pressure. The anatomy involved includes the tooth structure, particularly the dentin and pulp chamber. Disease progression can lead to irreversible pulpitis, where the inflammation becomes severe enough to necessitate endodontic treatment or tooth extraction. Diagnostic considerations include clinical examination, patient history, and radiographic imaging to assess the extent of the inflammation and rule out periapical pathology. Proper diagnosis is crucial as it influences treatment decisions and patient outcomes.

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

Endodontics

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

Pulpitis has significant clinical implications, as untreated cases can lead to severe pain, tooth loss, and systemic complications. Understanding the epidemiology of pulpitis helps in identifying at-risk populations and implementing preventive measures. Quality measures may include tracking treatment outcomes and patient satisfaction, which can influence healthcare utilization patterns and overall dental health in the community.

ICD-9 vs ICD-10

Pulpitis has significant clinical implications, as untreated cases can lead to severe pain, tooth loss, and systemic complications. Understanding the epidemiology of pulpitis helps in identifying at-risk populations and implementing preventive measures. Quality measures may include tracking treatment outcomes and patient satisfaction, which can influence healthcare utilization patterns and overall dental health in the community.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the treatment provided, such as endodontic therapy. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include thorough documentation of symptoms, treatment rationale, 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 K04.0?

K04.0 specifically covers cases of pulpitis, which may be classified as reversible or irreversible based on the severity of the inflammation and the presence of symptoms. It does not cover pulp necrosis or other dental conditions.

When should K04.0 be used instead of related codes?

K04.0 should be used when the diagnosis is specifically pulpitis without necrosis. If there is evidence of necrosis or other complications, codes such as K04.1 should be considered.

What documentation supports K04.0?

Documentation should include clinical findings, patient-reported symptoms, diagnostic imaging results, and treatment plans. Detailed notes on the nature of the pulpitis and any relevant history are essential.