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ICD-10 Guide
ICD-10 CodesK05.4

K05.4

Billable

Periodontosis

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

Code Description

ICD-10 K05.4 is a billable code used to indicate a diagnosis of periodontosis.

Key Diagnostic Point:

Periodontosis, also known as chronic periodontitis, is a progressive inflammatory disease affecting the supporting structures of the teeth, primarily the periodontal ligament and alveolar bone. Clinically, it presents with symptoms such as gum inflammation, pocket formation, and potential tooth mobility. The disease is characterized by the loss of attachment and bone, which can lead to tooth loss if not managed appropriately. The anatomy involved includes the gums (gingiva), periodontal ligaments, and the alveolar bone that supports the teeth. Disease progression can vary, often influenced by factors such as oral hygiene, smoking, diabetes, and genetic predisposition. Diagnosis typically involves clinical examination, probing depths, and radiographic evaluation to assess bone loss. Early detection and intervention are crucial to prevent severe complications and maintain oral health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and radiographic assessment.
  • Treatment complexity: May involve non-surgical and surgical interventions.
  • Documentation requirements: Detailed records of clinical findings and treatment plans are necessary.
  • Coding specificity: Requires accurate coding to differentiate from other periodontal diseases.

Audit Risk Factors

  • Common coding errors: Misclassification with other periodontal diseases.
  • Documentation gaps: Incomplete records of clinical findings.
  • Billing challenges: Potential denials due to lack of supporting documentation.

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

Periodontosis significantly impacts oral health and can lead to systemic health issues if untreated. It is prevalent among adults, with a notable correlation to conditions such as diabetes and cardiovascular diseases. Effective management of periodontosis can improve quality of life, reduce healthcare costs associated with dental and systemic complications, and enhance population health outcomes through preventive measures and education.

ICD-9 vs ICD-10

Periodontosis significantly impacts oral health and can lead to systemic health issues if untreated. It is prevalent among adults, with a notable correlation to conditions such as diabetes and cardiovascular diseases. Effective management of periodontosis can improve quality of life, reduce healthcare costs associated with dental and systemic complications, and enhance population health outcomes through preventive measures and education.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of treatment, which may involve both non-surgical and surgical interventions. Common denials can occur if documentation does not clearly support the diagnosis or if the treatment provided does not align with the documented condition. Best practices include ensuring that all clinical findings are well-documented and that the treatment plan is clearly articulated to support the coding.

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 K05.4?

K05.4 covers chronic periodontitis, characterized by inflammation and progressive attachment loss. It is essential to differentiate it from other periodontal diseases such as gingivitis or localized periodontitis.

When should K05.4 be used instead of related codes?

K05.4 should be used when there is evidence of chronic periodontitis with attachment loss and bone resorption, as opposed to K05.3 which is for localized forms of the disease.

What documentation supports K05.4?

Documentation should include clinical examination findings, probing depths, radiographic evidence of bone loss, and treatment plans. Comprehensive records are crucial for accurate coding and reimbursement.