Code Description

ICD-10 K05.313 is a billable code used to indicate a diagnosis of chronic periodontitis, localized, severe.

Key Diagnostic Point:

Chronic periodontitis, localized, severe, is a significant dental condition characterized by the inflammation and destruction of the supporting structures of the teeth, including the gums, periodontal ligament, and alveolar bone. Clinically, it presents with symptoms such as gum recession, deep periodontal pockets, and tooth mobility. The disease primarily affects localized areas of the mouth, often leading to severe attachment loss and bone loss around specific teeth. The progression of chronic periodontitis can vary, but it typically involves a slow and progressive course, exacerbated by factors such as poor oral hygiene, smoking, and systemic conditions like diabetes. Diagnosis is made through clinical examination, probing depth measurements, and radiographic assessment to evaluate bone loss. It is crucial for healthcare providers to differentiate chronic periodontitis from other periodontal diseases, such as aggressive periodontitis or gingivitis, to ensure appropriate management and treatment strategies are employed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Diagnostic complexity: Requires thorough clinical evaluation and understanding of periodontal disease progression.
Treatment complexity: Involves multi-disciplinary approaches including scaling, root planing, and possibly surgical interventions.
Documentation requirements: Detailed documentation of clinical findings, treatment plans, and patient compliance is essential.
Coding specificity: Requires precise coding to reflect the severity and localization of the disease.

Audit Risk Factors

Common coding errors: Misclassification of the severity of periodontitis.
Documentation gaps: Incomplete records of clinical findings or treatment plans.
Billing challenges: Potential denials due to insufficient documentation supporting the severity of the condition.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic periodontitis, particularly in its severe localized form, has significant clinical implications, affecting not only oral health but also overall systemic health. It is associated with increased healthcare utilization due to the need for ongoing dental care and potential complications such as tooth loss. The condition is prevalent in various populations, particularly among those with risk factors such as diabetes and smoking. Addressing chronic periodontitis can improve quality measures related to oral health and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

Chronic periodontitis, particularly in its severe localized form, has significant clinical implications, affecting not only oral health but also overall systemic health. It is associated with increased healthcare utilization due to the need for ongoing dental care and potential complications such as tooth loss. The condition is prevalent in various populations, particularly among those with risk factors such as diabetes and smoking. Addressing chronic periodontitis can improve quality measures related to oral health and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Chronic periodontitis, particularly in its severe localized form, has significant clinical implications, affecting not only oral health but also overall systemic health. It is associated with increased healthcare utilization due to the need for ongoing dental care and potential complications such as tooth loss. The condition is prevalent in various populations, particularly among those with risk factors such as diabetes and smoking. Addressing chronic periodontitis can improve quality measures related to oral health and reduce the burden on healthcare systems.

Resources

Clinical References

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ICD-10 Official Guidelines for K00-K99
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Clinical Documentation Requirements

Coding & Billing References

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ICD-10 Official Guidelines for K00-K99
•
Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K05.313?

K05.313 specifically covers chronic periodontitis that is localized and severe, characterized by significant attachment loss and periodontal pocket formation in specific areas of the mouth.

When should K05.313 be used instead of related codes?

K05.313 should be used when the clinical evaluation indicates severe localized chronic periodontitis, as opposed to moderate or slight forms of the disease, which would be coded differently.

What documentation supports K05.313?

Documentation should include clinical examination findings, probing depths, radiographic evidence of bone loss, and a comprehensive treatment plan that addresses the severity of the condition.