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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK05

K05

Non-billable

Gingivitis and periodontal diseases

Chapter 11:Diseases of the digestive system

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

Code Description

ICD-10 K05 is a used to indicate a diagnosis of gingivitis and periodontal diseases.

Key Diagnostic Point:

Gingivitis and periodontal diseases encompass a range of inflammatory conditions affecting the gums and supporting structures of the teeth. Clinically, gingivitis is characterized by redness, swelling, and bleeding of the gums, often resulting from plaque accumulation. If untreated, it can progress to periodontal disease, which involves the loss of connective tissue and bone supporting the teeth, potentially leading to tooth mobility and loss. The anatomy involved includes the gingiva, periodontal ligament, cementum, and alveolar bone. Disease progression typically starts with gingivitis, which is reversible with proper oral hygiene, but can advance to periodontitis, a more severe form that may require surgical intervention. Diagnostic considerations include clinical examination, probing depths, radiographic evaluation, and assessment of attachment loss. Early diagnosis and treatment are crucial to prevent irreversible damage and maintain oral health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and may involve multiple diagnostic tests.
  • Treatment complexity: Moderate, with options ranging from non-surgical management to surgical interventions.
  • Documentation requirements: Moderate, necessitating detailed records of clinical findings and treatment plans.
  • Coding specificity: Medium, as it requires precise coding to differentiate between types of periodontal diseases.

Audit Risk Factors

  • Common coding errors: Misclassification of gingivitis as periodontitis.
  • Documentation gaps: Incomplete records of clinical findings and treatment outcomes.
  • Billing challenges: Denials due to insufficient documentation supporting the diagnosis.

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

Periodontology

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 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

Gingivitis and periodontal diseases significantly impact population health, contributing to systemic conditions such as cardiovascular disease and diabetes. Effective management can improve quality measures related to oral health and reduce healthcare utilization patterns associated with advanced periodontal disease. Epidemiologically, these conditions are prevalent, affecting a large portion of the adult population, highlighting the need for preventive care and early intervention.

ICD-9 vs ICD-10

Gingivitis and periodontal diseases significantly impact population health, contributing to systemic conditions such as cardiovascular disease and diabetes. Effective management can improve quality measures related to oral health and reduce healthcare utilization patterns associated with advanced periodontal disease. Epidemiologically, these conditions are prevalent, affecting a large portion of the adult population, highlighting the need for preventive care and early intervention.

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance coverage for dental services, which may vary significantly. Common denials can occur if documentation does not clearly support the diagnosis or if the treatment provided is not covered under the patient's plan. Best practices include ensuring that all clinical findings are well-documented and that treatment plans align with the diagnosis to facilitate smoother billing processes.

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 K05?

K05 covers gingivitis, chronic periodontitis, aggressive periodontitis, and other specified periodontal diseases. Each condition has distinct diagnostic criteria, including clinical signs of inflammation, probing depths, and radiographic evidence of bone loss.

When should K05 be used instead of related codes?

K05 should be used when the primary diagnosis is gingivitis or periodontal disease. It is important to differentiate it from K04, which pertains to other dental diseases, by assessing the clinical presentation and severity of the condition.

What documentation supports K05?

Documentation must include a thorough clinical examination, periodontal charting, radiographic findings, and treatment plans. Evidence of patient education on oral hygiene practices and follow-up care is also essential.