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ICD-10 Guide
ICD-10 CodesK04.99

K04.99

Billable

Other diseases of pulp and periapical tissues

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

Code Description

ICD-10 K04.99 is a billable code used to indicate a diagnosis of other diseases of pulp and periapical tissues.

Key Diagnostic Point:

K04.99 refers to other diseases of pulp and periapical tissues, which are critical components of dental health. The pulp is the innermost part of the tooth containing nerves and blood vessels, while periapical tissues surround the root of the tooth. Diseases affecting these areas can lead to significant pain, infection, and tooth loss. Clinical presentations may include acute or chronic pulpitis, periapical abscesses, and periapical granulomas. The progression of these diseases often begins with dental caries or trauma, leading to inflammation and infection. Diagnostic considerations include clinical examination, radiographic imaging, and pulp vitality tests to assess the health of the pulp and surrounding tissues. Treatment may involve endodontic therapy, such as root canal treatment, or extraction in severe cases. Accurate diagnosis and coding are essential for effective treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and imaging.
  • Treatment complexity: Involves various treatment modalities, including surgical and non-surgical options.
  • Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is necessary.
  • Coding specificity: Requires precise coding to differentiate between types of pulp and periapical diseases.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of pulp disease.
  • Documentation gaps: Incomplete records of symptoms or treatment plans.
  • Billing challenges: Denials due to insufficient documentation or incorrect coding.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K04.99 lies in its association with dental health and overall well-being. Diseases of the pulp and periapical tissues can lead to severe pain and complications if left untreated, impacting population health. Effective management of these conditions can reduce healthcare utilization patterns, such as emergency visits for dental pain. Additionally, monitoring these conditions contributes to quality measures in dental care, emphasizing the importance of preventive care and early intervention.

ICD-9 vs ICD-10

The clinical significance of K04.99 lies in its association with dental health and overall well-being. Diseases of the pulp and periapical tissues can lead to severe pain and complications if left untreated, impacting population health. Effective management of these conditions can reduce healthcare utilization patterns, such as emergency visits for dental pain. Additionally, monitoring these conditions contributes to quality measures in dental care, emphasizing the importance of preventive care and early intervention.

Reimbursement & Billing Impact

The clinical significance of K04.99 lies in its association with dental health and overall well-being. Diseases of the pulp and periapical tissues can lead to severe pain and complications if left untreated, impacting population health. Effective management of these conditions can reduce healthcare utilization patterns, such as emergency visits for dental pain. Additionally, monitoring these conditions contributes to quality measures in dental care, emphasizing the importance of preventive care and early intervention.

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 K04.99?

K04.99 covers a variety of conditions affecting the pulp and periapical tissues, including chronic pulpitis, periapical cysts, and other non-specific pulp diseases that do not fall under more specific codes.

When should K04.99 be used instead of related codes?

K04.99 should be used when the specific type of pulp or periapical disease is not clearly defined by other codes. It is appropriate when the diagnosis is vague or when multiple conditions are present.

What documentation supports K04.99?

Documentation should include clinical findings, diagnostic imaging results, treatment plans, and any relevant patient history that supports the diagnosis of pulp and periapical diseases.