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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK06

K06

Non-billable

Other disorders of gingiva and edentulous alveolar ridge

Chapter 11:Diseases of the digestive system

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

Code Description

ICD-10 K06 is a used to indicate a diagnosis of other disorders of gingiva and edentulous alveolar ridge.

Key Diagnostic Point:

K06 encompasses various disorders of the gingiva and edentulous alveolar ridge, which are critical components of the oral cavity involved in the digestive system. Clinical presentations may include gingival hyperplasia, gingivitis, and periodontitis, leading to inflammation, swelling, and potential loss of attachment to the teeth. The anatomy involved includes the gums (gingiva) that surround the teeth and the edentulous alveolar ridge, which is the bony ridge that supports the teeth. Disease progression can vary from mild inflammation to severe periodontal disease, which may result in tooth loss and impact overall health. Diagnostic considerations include clinical examination, probing depths, radiographic evaluation, and possibly biopsy for atypical lesions. It is essential to differentiate these disorders from other oral conditions, as they can significantly affect a patient's nutritional intake and overall health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and differentiation from other oral pathologies.
  • Treatment complexity: May involve non-surgical and surgical interventions, including scaling, root planing, and periodontal surgery.
  • Documentation requirements: Detailed documentation of clinical findings, treatment plans, and patient responses is necessary.
  • Coding specificity: Requires accurate coding to reflect the specific type of gingival disorder.

Audit Risk Factors

  • Common coding errors: Misclassification of gingival disorders or failure to document the severity.
  • Documentation gaps: Incomplete records regarding treatment plans or patient follow-up.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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 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

The clinical significance of K06 lies in its potential to affect oral health and overall well-being. Disorders of the gingiva can lead to systemic health issues, including cardiovascular disease and diabetes complications. Population health impact is notable, as periodontal diseases are prevalent and can affect quality of life. Quality measures often include the management of gingival disorders, influencing healthcare utilization patterns and emphasizing the need for preventive care and early intervention.

ICD-9 vs ICD-10

The clinical significance of K06 lies in its potential to affect oral health and overall well-being. Disorders of the gingiva can lead to systemic health issues, including cardiovascular disease and diabetes complications. Population health impact is notable, as periodontal diseases are prevalent and can affect quality of life. Quality measures often include the management of gingival disorders, influencing healthcare utilization patterns and emphasizing the need for preventive care and early intervention.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the disorder and the interventions performed. Common denials may arise from insufficient documentation or incorrect coding. Best practices include ensuring that all clinical findings are well-documented and that the coding accurately reflects the services provided. Regular audits and training can help mitigate billing challenges.

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 K06?

K06 covers a range of conditions including chronic gingivitis, acute necrotizing ulcerative gingivitis, gingival hyperplasia, and disorders of the edentulous alveolar ridge. Each condition has specific diagnostic criteria based on clinical presentation and severity.

When should K06 be used instead of related codes?

K06 should be used when the patient presents with specific disorders of the gingiva or edentulous ridge that do not fall under more specific codes like K05. It is essential to assess the clinical findings and treatment needs to select the appropriate code.

What documentation supports K06?

Documentation must include clinical examination findings, treatment plans, patient history, and any relevant imaging studies. Detailed notes on the progression of the disorder and response to treatment are also crucial.