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ICD-10 Guide
ICD-10 CodesK04.9

K04.9

Non-billable

Other and unspecified diseases of pulp and periapical tissues

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

Code Description

ICD-10 K04.9 is a used to indicate a diagnosis of other and unspecified diseases of pulp and periapical tissues.

Key Diagnostic Point:

K04.9 refers to 'Other and unspecified diseases of pulp and periapical tissues,' which encompasses a range of dental pulp diseases that may not fit into more specific categories. The dental pulp is the innermost part of the tooth, containing nerves and blood vessels, while periapical tissues surround the apex of the tooth root. Clinical presentations can include pain, swelling, and sensitivity to temperature changes, often indicating inflammation or infection. Disease progression may lead to pulp necrosis or abscess formation if left untreated. Diagnostic considerations involve clinical examination, radiographic imaging, and possibly pulp vitality tests to assess the health of the pulp tissue. This code is often used when the specific nature of the pulp disease is not clearly defined, necessitating further evaluation to determine the underlying cause and appropriate treatment plan.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and imaging.
  • Treatment complexity: May involve endodontic procedures or referrals to specialists.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Limited specificity may lead to challenges in accurate coding.

Audit Risk Factors

  • Common coding errors: Misapplication of more specific codes when K04.9 is appropriate.
  • Documentation gaps: Insufficient clinical detail to support the diagnosis.
  • Billing challenges: Potential for claim denials if documentation does not align with coding.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K04.9 lies in its association with dental health and the potential for complications if pulp diseases are not addressed. Population health impact includes the prevalence of dental caries and periodontal disease, which can lead to pulp and periapical issues. Quality measures may focus on timely diagnosis and treatment of dental conditions, influencing healthcare utilization patterns and overall oral health outcomes in the community.

ICD-9 vs ICD-10

The clinical significance of K04.9 lies in its association with dental health and the potential for complications if pulp diseases are not addressed. Population health impact includes the prevalence of dental caries and periodontal disease, which can lead to pulp and periapical issues. Quality measures may focus on timely diagnosis and treatment of dental conditions, influencing healthcare utilization patterns and overall oral health outcomes in the community.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of demonstrating medical necessity for procedures related to pulp and periapical diseases. Common denials may arise from insufficient documentation or failure to provide adequate justification for the use of K04.9. Best practices include ensuring that all clinical notes are detailed and align with the coding to support claims effectively.

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 K04.9?

K04.9 covers a variety of pulp and periapical diseases that do not have a specific diagnosis, including undetermined pulpitis, periapical inflammation, and other nonspecific pulp conditions.

When should K04.9 be used instead of related codes?

K04.9 should be used when the specific nature of the pulp or periapical disease is unclear or when the clinician has not determined a more specific diagnosis.

What documentation supports K04.9?

Documentation should include a comprehensive clinical examination, radiographic findings, and any relevant patient history that supports the diagnosis of an unspecified pulp or periapical condition.