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ICD-10 Guide
ICD-10 CodesK05.0

K05.0

Non-billable

Acute gingivitis

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

Code Description

ICD-10 K05.0 is a used to indicate a diagnosis of acute gingivitis.

Key Diagnostic Point:

Acute gingivitis is characterized by the inflammation of the gingiva, the soft tissue surrounding the teeth. Clinically, it presents with symptoms such as redness, swelling, and bleeding of the gums, particularly during brushing or flossing. The condition is often associated with plaque accumulation, poor oral hygiene, and can be exacerbated by systemic factors such as hormonal changes, smoking, or certain medications. The anatomy involved primarily includes the gingival tissue, which is supported by the underlying alveolar bone. Disease progression can lead to more severe periodontal diseases if left untreated, potentially resulting in tooth loss. Diagnostic considerations for acute gingivitis include a thorough clinical examination, patient history, and possibly radiographic evaluation to assess the health of the supporting structures of the teeth. It is crucial to differentiate acute gingivitis from other periodontal diseases, such as chronic gingivitis or periodontitis, which may require different management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate; requires clinical examination and patient history.
  • Treatment complexity: Moderate; involves patient education and possible referral to dental specialists.
  • Documentation requirements: Moderate; must document clinical findings and treatment plans.
  • Coding specificity: High; specific to acute gingivitis and differentiates from chronic conditions.

Audit Risk Factors

  • Common coding errors: Misclassification as chronic gingivitis.
  • Documentation gaps: Incomplete patient history or lack of clinical findings.
  • Billing challenges: Potential denials if documentation does not support 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

Primary Care

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

Acute gingivitis has significant clinical implications as it can lead to more severe periodontal diseases if not addressed promptly. It affects a substantial portion of the population, particularly those with poor oral hygiene practices. Addressing acute gingivitis through preventive measures can improve overall oral health, reduce healthcare utilization related to dental emergencies, and enhance quality measures in dental care.

ICD-9 vs ICD-10

Acute gingivitis has significant clinical implications as it can lead to more severe periodontal diseases if not addressed promptly. It affects a substantial portion of the population, particularly those with poor oral hygiene practices. Addressing acute gingivitis through preventive measures can improve overall oral health, reduce healthcare utilization related to dental emergencies, and enhance quality measures in dental care.

Reimbursement & Billing Impact

Reimbursement considerations may vary by payer, but typically include coverage for dental cleanings and treatments aimed at reducing inflammation. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining detailed records of patient assessments, treatment plans, and follow-up care to substantiate claims.

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 K05.0?

K05.0 specifically covers acute gingivitis, which is characterized by rapid onset inflammation of the gums, often due to plaque buildup. It does not include chronic forms of gingivitis or other periodontal diseases.

When should K05.0 be used instead of related codes?

K05.0 should be used when the patient presents with acute symptoms of gingival inflammation. It is important to differentiate it from chronic gingivitis (K05.1) or other periodontal diseases based on the duration and severity of symptoms.

What documentation supports K05.0?

Documentation should include clinical findings such as the presence of gingival inflammation, bleeding on probing, and patient-reported symptoms. A thorough dental examination and treatment plan should also be recorded.