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ICD-10 Guide
ICD-10 CodesK08.191

K08.191

Billable

Complete loss of teeth due to other specified cause, class I

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

Code Description

ICD-10 K08.191 is a billable code used to indicate a diagnosis of complete loss of teeth due to other specified cause, class i.

Key Diagnostic Point:

K08.191 refers to complete loss of teeth due to other specified causes, classified as class I. This condition can arise from various factors, including systemic diseases, trauma, or dental neglect. Clinically, patients may present with complete edentulism, which significantly impacts their ability to chew, speak, and maintain proper nutrition. The anatomy involved primarily includes the maxilla and mandible, as well as the surrounding periodontal structures. Disease progression can vary; for instance, conditions like diabetes or osteoporosis may exacerbate tooth loss over time. Diagnostic considerations include a thorough dental examination, radiographic imaging, and a review of the patient's medical history to identify underlying causes. It is essential to differentiate this code from other forms of tooth loss, such as those due to periodontal disease (K05.9) or trauma (S02.6). Accurate coding is crucial for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of various underlying causes.
  • Treatment complexity: May involve multidisciplinary approaches including dental, medical, and nutritional interventions.
  • Documentation requirements: Detailed patient history and clinical findings are necessary.
  • Coding specificity: Must differentiate from other tooth loss codes.

Audit Risk Factors

  • Common coding errors: Misclassification of tooth loss causes.
  • Documentation gaps: Incomplete patient history or lack of supporting evidence.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

Specialty Focus

Medical Specialties

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

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K08.191 lies in its association with broader health issues, as complete tooth loss can lead to malnutrition, speech difficulties, and psychosocial impacts. Population health studies indicate that edentulism is prevalent in older adults, often correlating with chronic diseases. Addressing this condition can improve quality of life and reduce healthcare utilization by preventing complications related to poor nutrition and oral health.

ICD-9 vs ICD-10

The clinical significance of K08.191 lies in its association with broader health issues, as complete tooth loss can lead to malnutrition, speech difficulties, and psychosocial impacts. Population health studies indicate that edentulism is prevalent in older adults, often correlating with chronic diseases. Addressing this condition can improve quality of life and reduce healthcare utilization by preventing complications related to poor nutrition and oral health.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the underlying cause and treatment provided. Common denials can arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include thorough documentation of the patient's condition and treatment plan, as well as regular updates to coding practices to reflect any changes in guidelines or payer requirements.

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 K08.191?

K08.191 covers complete loss of teeth due to conditions such as systemic diseases (e.g., diabetes, cancer), trauma, or other specified causes that do not fall under periodontal disease or trauma-related codes.

When should K08.191 be used instead of related codes?

K08.191 should be used when the complete loss of teeth is attributed to specific causes other than periodontal disease or trauma, ensuring that the underlying condition is well-documented.

What documentation supports K08.191?

Documentation should include a comprehensive dental examination, radiographic evidence, and a detailed medical history that outlines the specific causes of tooth loss, along with any relevant treatment plans.