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ICD-10 Guide
ICD-10 CodesK06.01

K06.01

Non-billable

Gingival recession, localized

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

Code Description

ICD-10 K06.01 is a used to indicate a diagnosis of gingival recession, localized.

Key Diagnostic Point:

Gingival recession, localized, refers to the apical migration of the gingival margin, resulting in exposure of the root surface of the tooth. This condition is characterized by the loss of gum tissue, which can lead to increased sensitivity, aesthetic concerns, and potential periodontal disease. The anatomy involved includes the gingiva, which is the soft tissue surrounding the teeth, and the underlying alveolar bone. Gingival recession can progress due to various factors, including periodontal disease, aggressive tooth brushing, anatomical factors, and tobacco use. Clinically, it presents as a visible loss of gum tissue, often accompanied by tooth sensitivity and a change in the appearance of the smile. Diagnosis typically involves clinical examination and may include periodontal probing to assess the depth of the recession and the health of the surrounding tissues. Radiographic evaluation may also be necessary to assess the underlying bone structure. Early diagnosis and intervention are crucial to prevent further recession and associated complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical examination and understanding of periodontal health.
  • Treatment complexity: May involve non-surgical and surgical interventions depending on severity.
  • Documentation requirements: Detailed documentation of clinical findings and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other periodontal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other periodontal diseases.
  • Documentation gaps: Incomplete records of clinical findings and treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

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

Gingival recession has significant clinical implications, affecting not only oral health but also overall quality of life. It can lead to increased dental sensitivity, aesthetic concerns, and potential tooth loss if untreated. The condition is prevalent in various populations, particularly among older adults and those with poor oral hygiene practices. Understanding and addressing gingival recession is essential for improving population health outcomes, as it can influence healthcare utilization patterns and the need for more extensive dental interventions.

ICD-9 vs ICD-10

Gingival recession has significant clinical implications, affecting not only oral health but also overall quality of life. It can lead to increased dental sensitivity, aesthetic concerns, and potential tooth loss if untreated. The condition is prevalent in various populations, particularly among older adults and those with poor oral hygiene practices. Understanding and addressing gingival recession is essential for improving population health outcomes, as it can influence healthcare utilization patterns and the need for more extensive dental interventions.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for surgical interventions and ensuring that the documentation aligns with the services billed. Common denials may arise from insufficient documentation or coding errors, so it is crucial to maintain thorough records of patient assessments, treatment plans, and follow-up care. Best practices include using clear and specific language in documentation and ensuring that all services rendered are supported by the clinical findings.

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 K06.01?

K06.01 specifically covers localized gingival recession, which may be associated with periodontal disease, trauma, or anatomical predispositions. It does not include generalized recession or other periodontal conditions.

When should K06.01 be used instead of related codes?

K06.01 should be used when there is clear evidence of localized gingival recession. If the recession is generalized or part of a broader periodontal disease process, other codes may be more appropriate.

What documentation supports K06.01?

Documentation should include clinical examination findings, measurements of recession, patient history, and any relevant treatment plans. Photographic evidence may also support the diagnosis.