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ICD-10 Guide
ICD-10 CodesK08.131

K08.131

Billable

Complete loss of teeth due to caries, class I

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

Code Description

ICD-10 K08.131 is a billable code used to indicate a diagnosis of complete loss of teeth due to caries, class i.

Key Diagnostic Point:

K08.131 refers to complete loss of teeth due to caries, class I, which indicates a significant dental condition characterized by the total loss of teeth primarily resulting from dental caries (tooth decay). This condition affects the oral cavity, specifically the teeth and surrounding structures. The progression of caries can lead to severe tooth decay, which, if untreated, results in the complete loss of teeth. Clinically, patients may present with symptoms such as pain, difficulty chewing, and aesthetic concerns. The anatomy involved includes the enamel, dentin, and pulp of the teeth, as well as the supporting structures like the gums and jawbone. Diagnostic considerations for K08.131 involve thorough dental examinations, radiographic assessments, and patient history to confirm the extent of tooth loss and the underlying causes. Proper identification of this code is crucial for accurate treatment planning and management of oral health, as well as for understanding the broader implications of tooth loss on gastrointestinal health, given the role of teeth in the initial stages of digestion.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough dental evaluation and imaging.
  • Treatment complexity: May involve restorative procedures, dentures, or implants.
  • Documentation requirements: Detailed records of dental history and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of tooth loss severity.
  • Documentation gaps: Incomplete dental records or lack of imaging.
  • Billing challenges: Issues with insurance coverage for restorative procedures.

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: Oral and Maxillofacial Surgery

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

The clinical significance of K08.131 extends beyond dental health, as complete tooth loss can impact nutrition and overall health. Population health studies indicate a correlation between tooth loss and increased risk of gastrointestinal disorders due to compromised chewing ability. Quality measures may include tracking the prevalence of tooth loss and the effectiveness of preventive dental care. Understanding healthcare utilization patterns related to K08.131 can inform public health initiatives aimed at reducing dental caries and improving oral health outcomes.

ICD-9 vs ICD-10

The clinical significance of K08.131 extends beyond dental health, as complete tooth loss can impact nutrition and overall health. Population health studies indicate a correlation between tooth loss and increased risk of gastrointestinal disorders due to compromised chewing ability. Quality measures may include tracking the prevalence of tooth loss and the effectiveness of preventive dental care. Understanding healthcare utilization patterns related to K08.131 can inform public health initiatives aimed at reducing dental caries and improving oral health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of restorative procedures or prosthetics, which may be subject to insurance coverage limitations. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to tooth loss. Best practices include ensuring all documentation is complete and accurate, and that coding aligns with the services rendered.

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 K08.131?

K08.131 specifically covers complete loss of teeth due to caries classified as class I, indicating that the loss is primarily due to untreated dental decay. It does not cover tooth loss due to trauma or periodontal disease.

When should K08.131 be used instead of related codes?

K08.131 should be used when there is a complete loss of teeth attributed specifically to caries. If there is partial loss or if the cause is related to periodontal disease or trauma, other codes should be considered.

What documentation supports K08.131?

Documentation should include a comprehensive dental examination, radiographic evidence of caries, treatment history, and any relevant patient symptoms that indicate the extent of tooth loss.