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ICD-10 Guide
ICD-10 CodesK05.10

K05.10

Billable

Chronic gingivitis, plaque induced

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

Code Description

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

Key Diagnostic Point:

Chronic gingivitis, plaque induced, is a common inflammatory condition affecting the gingiva, characterized by the presence of plaque and calculus on the teeth. Clinically, it presents with symptoms such as redness, swelling, and bleeding of the gums, particularly during brushing or flossing. The anatomy involved primarily includes the gingival tissue surrounding the teeth, which can become inflamed due to the accumulation of bacterial biofilm. Disease progression can lead to more severe periodontal diseases if left untreated, potentially resulting in tooth loss and systemic health issues. Diagnostic considerations include a thorough clinical examination, probing depths, and radiographic assessments to evaluate the extent of periodontal involvement. The diagnosis is typically confirmed through the identification of plaque and calculus, along with clinical signs of inflammation. Regular dental check-ups and proper oral hygiene practices are essential for managing and preventing chronic gingivitis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and may involve differential diagnosis.
  • Treatment complexity: Moderate, involving both non-surgical and surgical interventions depending on severity.
  • Documentation requirements: Requires detailed documentation of clinical findings and treatment plans.
  • Coding specificity: Specific to chronic gingivitis caused by plaque, differentiating it from other types of gingivitis.

Audit Risk Factors

  • Common coding errors: Misclassification of gingivitis types.
  • Documentation gaps: Incomplete records of patient history and treatment.
  • Billing challenges: Issues with insurance coverage for preventive versus treatment services.

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: 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 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 if not managed effectively. Population health impact includes increased healthcare utilization for dental treatments and potential links to systemic health issues such as cardiovascular disease. Quality measures often focus on preventive care and patient education to reduce the prevalence of gingivitis and improve overall oral health outcomes.

ICD-9 vs ICD-10

Chronic gingivitis has significant clinical implications, as it can lead to more severe periodontal diseases if not managed effectively. Population health impact includes increased healthcare utilization for dental treatments and potential links to systemic health issues such as cardiovascular disease. Quality measures often focus on preventive care and patient education to reduce the prevalence of gingivitis and improve overall oral health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include verifying that the services rendered are covered under the patient's insurance plan. Common denials may arise from insufficient documentation or coding errors. Best practices include maintaining clear records of patient visits, treatment plans, and follow-up care to support claims and reduce the risk of audits.

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 K05.10?

K05.10 specifically covers chronic gingivitis that is plaque-induced, characterized by inflammation of the gums due to the accumulation of dental plaque. It does not include other forms of gingivitis that may be caused by systemic diseases or other factors.

When should K05.10 be used instead of related codes?

K05.10 should be used when the gingivitis is specifically due to plaque accumulation. If the gingivitis is due to other causes, such as hormonal changes or systemic conditions, other codes like K05.11 or K05.12 should be considered.

What documentation supports K05.10?

Documentation should include clinical findings such as the presence of plaque, gingival inflammation, bleeding on probing, and any treatment provided. A thorough dental examination and patient history are essential for supporting the diagnosis.