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ICD-10 Guide
ICD-10 CodesK05.01

K05.01

Billable

Acute gingivitis, non-plaque induced

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

Code Description

ICD-10 K05.01 is a billable code used to indicate a diagnosis of acute gingivitis, non-plaque induced.

Key Diagnostic Point:

Acute gingivitis, non-plaque induced, is characterized by inflammation of the gingiva that occurs without the presence of dental plaque. Clinically, patients may present with swollen, red, and bleeding gums, often accompanied by discomfort or pain during oral hygiene practices. The condition can arise from various factors, including hormonal changes, systemic diseases, or certain medications that alter the oral environment. The anatomy involved primarily includes the gingival tissues surrounding the teeth, which are critical for oral health and stability. Disease progression can lead to more severe periodontal diseases if not addressed promptly. Diagnostic considerations include a thorough clinical examination, patient history, and potentially the exclusion of underlying systemic conditions that may contribute to the gingival inflammation. Laboratory tests may be warranted in cases where systemic disease is suspected, and a comprehensive oral evaluation is essential to differentiate non-plaque induced gingivitis from other forms of periodontal disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from plaque-induced gingivitis and other periodontal diseases.
  • Treatment complexity: Management may involve addressing underlying conditions and patient education on oral hygiene.
  • Documentation requirements: Detailed clinical notes and patient history are necessary for accurate coding.
  • Coding specificity: Requires precise coding to distinguish between types of gingivitis.

Audit Risk Factors

  • Common coding errors: Misclassification as plaque-induced 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K05.01 lies in its potential to progress to more severe periodontal diseases if left untreated. Population health impact includes the prevalence of gingivitis in various demographics, particularly among those with systemic conditions. Quality measures may focus on the effectiveness of preventive dental care and patient education in managing oral health. Healthcare utilization patterns reflect the need for regular dental visits to prevent complications associated with gingivitis, highlighting the importance of early diagnosis and intervention in improving overall health outcomes.

ICD-9 vs ICD-10

The clinical significance of K05.01 lies in its potential to progress to more severe periodontal diseases if left untreated. Population health impact includes the prevalence of gingivitis in various demographics, particularly among those with systemic conditions. Quality measures may focus on the effectiveness of preventive dental care and patient education in managing oral health. Healthcare utilization patterns reflect the need for regular dental visits to prevent complications associated with gingivitis, highlighting the importance of early diagnosis and intervention in improving overall health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include verifying insurance coverage for dental evaluations and treatments related to gingival health. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity, so thorough record-keeping and adherence to coding guidelines are essential for successful claims processing.

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 K05.01?

K05.01 specifically covers acute gingivitis that is not associated with plaque accumulation. This can include cases related to hormonal changes, systemic diseases like diabetes, or reactions to medications.

When should K05.01 be used instead of related codes?

K05.01 should be used when the gingivitis is clearly identified as non-plaque induced, particularly when other causes such as systemic conditions or hormonal changes are present, differentiating it from K05.00.

What documentation supports K05.01?

Documentation should include a detailed clinical examination, patient history indicating potential non-plaque related causes, and any relevant laboratory findings that support the diagnosis of acute non-plaque induced gingivitis.