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ICD-10 Guide
ICD-10 CodesK05.1

K05.1

Non-billable

Chronic gingivitis

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

Code Description

ICD-10 K05.1 is a used to indicate a diagnosis of chronic gingivitis.

Key Diagnostic Point:

Chronic gingivitis is a common inflammatory condition affecting the gingiva, characterized by redness, swelling, and bleeding of the gums. It is primarily caused by the accumulation of dental plaque, which harbors bacteria that irritate the gum tissue. The anatomy involved includes the gingiva, which is the soft tissue surrounding the teeth, and the underlying alveolar bone. Chronic gingivitis can progress to more severe periodontal diseases if left untreated, potentially leading to tooth loss and systemic health issues. Diagnosis typically involves a clinical examination, where the dentist assesses the presence of plaque, tartar, and the degree of gum inflammation. Radiographic imaging may be utilized to evaluate the extent of any bone loss. Patients may report symptoms such as gum bleeding during brushing or flossing, persistent bad breath, and a change in gum color. Effective management includes improved oral hygiene practices, professional dental cleanings, and patient education on maintaining oral health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and patient history.
  • Treatment complexity: Moderate, involving both preventive and therapeutic measures.
  • Documentation requirements: Requires thorough documentation of clinical findings and treatment plans.
  • Coding specificity: Moderate, as it is specific to chronic gingivitis but can be confused with other periodontal diseases.

Audit Risk Factors

  • Common coding errors: Misclassification of acute vs. chronic conditions.
  • Documentation gaps: Incomplete records of treatment and patient compliance.
  • Billing challenges: Potential denials due to lack of supporting documentation for chronicity.

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: Periodontics

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

Chronic gingivitis has significant clinical implications, as it can lead to more severe periodontal diseases, impacting overall oral health. Population health studies indicate a high prevalence of gingivitis, making it a critical focus for preventive dental care. Effective management of chronic gingivitis can improve quality measures in dental practices and reduce healthcare utilization related to advanced periodontal treatments.

ICD-9 vs ICD-10

Chronic gingivitis has significant clinical implications, as it can lead to more severe periodontal diseases, impacting overall oral health. Population health studies indicate a high prevalence of gingivitis, making it a critical focus for preventive dental care. Effective management of chronic gingivitis can improve quality measures in dental practices and reduce healthcare utilization related to advanced periodontal treatments.

Reimbursement & Billing Impact

reimbursement and minimize claim rejections.

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 K05.1?

K05.1 specifically covers chronic gingivitis, which may include conditions such as localized or generalized gingival inflammation due to plaque accumulation. It does not cover other periodontal diseases or acute gingivitis.

When should K05.1 be used instead of related codes?

K05.1 should be used when the patient presents with chronic gingivitis symptoms and a clinical diagnosis is established, differentiating it from acute conditions or other periodontal diseases.

What documentation supports K05.1?

Documentation should include clinical findings such as the presence of plaque, bleeding on probing, and patient history. Treatment plans and follow-up notes are also essential to support the chronic nature of the condition.