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ICD-10 Guide
ICD-10 CodesK04.4

K04.4

Billable

Acute apical periodontitis of pulpal origin

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

Code Description

ICD-10 K04.4 is a billable code used to indicate a diagnosis of acute apical periodontitis of pulpal origin.

Key Diagnostic Point:

Acute apical periodontitis of pulpal origin is an inflammatory condition affecting the periapical tissues of a tooth, typically resulting from pulp necrosis due to bacterial infection. Clinically, patients may present with localized pain, swelling, and tenderness upon percussion of the affected tooth. The anatomy involved includes the dental pulp, periapical tissues, and surrounding alveolar bone. Disease progression can lead to the development of an abscess if left untreated, which may further complicate the clinical picture. Diagnostic considerations include a thorough clinical examination, radiographic evaluation to assess periapical changes, and possibly pulp vitality tests. The condition is often associated with dental caries or trauma that compromises the pulp, necessitating prompt intervention to prevent further complications such as systemic infection or tooth loss.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical and radiographic evaluation to confirm diagnosis.
  • Treatment complexity: May involve endodontic therapy or extraction, depending on severity.
  • Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is essential.
  • Coding specificity: Requires accurate coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with chronic conditions.
  • Documentation gaps: Incomplete records of patient symptoms and treatment.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

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: 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 K04.4 lies in its potential to cause severe pain and complications if untreated, impacting patient quality of life and necessitating urgent care. Population health impact includes the prevalence of dental caries leading to pulp necrosis, which is a common issue in many communities. Quality measures may focus on timely diagnosis and treatment to prevent progression to more severe dental conditions, ultimately influencing healthcare utilization patterns and reducing emergency visits.

ICD-9 vs ICD-10

The clinical significance of K04.4 lies in its potential to cause severe pain and complications if untreated, impacting patient quality of life and necessitating urgent care. Population health impact includes the prevalence of dental caries leading to pulp necrosis, which is a common issue in many communities. Quality measures may focus on timely diagnosis and treatment to prevent progression to more severe dental conditions, ultimately influencing healthcare utilization patterns and reducing emergency visits.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, such as endodontic therapy, which may vary based on the tooth type and condition severity. Common denials may arise from insufficient documentation or incorrect coding. Best practices include ensuring that all clinical notes are complete and that the coding accurately reflects the diagnosis and treatment provided.

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 K04.4?

K04.4 specifically covers acute apical periodontitis resulting from pulp necrosis, often due to bacterial infection. It is characterized by acute inflammation of the periapical tissues and may present with pain and swelling.

When should K04.4 be used instead of related codes?

K04.4 should be used when the condition is acute and directly related to pulp necrosis. It is distinct from chronic conditions like K04.5, which involves a longer duration of symptoms and different management strategies.

What documentation supports K04.4?

Documentation should include a detailed clinical examination, patient-reported symptoms, radiographic findings indicating periapical changes, and treatment plans. Evidence of acute symptoms and the relationship to pulp necrosis is crucial.