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ICD-10 Guide
ICD-10 CodesK08.401

K08.401

Billable

Partial loss of teeth, unspecified cause, class I

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

Code Description

ICD-10 K08.401 is a billable code used to indicate a diagnosis of partial loss of teeth, unspecified cause, class i.

Key Diagnostic Point:

K08.401 refers to partial loss of teeth due to unspecified causes, classified as Class I. This condition typically presents with the loss of one or more teeth, which can significantly impact a patient's oral health, nutrition, and overall quality of life. The anatomy involved includes the dental structures such as the gums, alveolar bone, and the remaining teeth. Disease progression may vary, with potential causes including periodontal disease, trauma, or dental caries, leading to tooth loss. Diagnostic considerations involve a thorough clinical examination, radiographic evaluation, and patient history to determine the underlying cause of tooth loss. It is essential to differentiate this condition from other dental disorders, as the management may vary based on the etiology. Treatment options may include restorative procedures, prosthetics, or surgical interventions depending on the extent of tooth loss and the patient's overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation to determine the cause of tooth loss.
  • Treatment complexity: May involve multiple specialties including dentistry and oral surgery.
  • Documentation requirements: Detailed clinical notes and imaging studies are necessary.
  • Coding specificity: Requires accurate coding to reflect the specific nature of tooth loss.

Audit Risk Factors

  • Common coding errors: Misclassification of tooth loss severity.
  • Documentation gaps: Incomplete patient history or lack of imaging.
  • Billing challenges: Potential denials due to insufficient 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: 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 K08.401 lies in its potential impact on a patient's nutritional intake and overall health, as partial tooth loss can lead to difficulties in chewing and swallowing. This condition is prevalent in various populations, particularly among the elderly, and can contribute to broader public health issues such as malnutrition and oral health disparities. Quality measures may include tracking the prevalence of tooth loss and the effectiveness of interventions aimed at restoring dental function, thereby improving healthcare utilization patterns.

ICD-9 vs ICD-10

The clinical significance of K08.401 lies in its potential impact on a patient's nutritional intake and overall health, as partial tooth loss can lead to difficulties in chewing and swallowing. This condition is prevalent in various populations, particularly among the elderly, and can contribute to broader public health issues such as malnutrition and oral health disparities. Quality measures may include tracking the prevalence of tooth loss and the effectiveness of interventions aimed at restoring dental function, thereby improving healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of demonstrating medical necessity for procedures related to tooth loss. Common denials may arise from insufficient documentation or failure to provide evidence of the underlying cause of tooth loss. Best practices include thorough record-keeping and ensuring that all claims are supported by appropriate clinical documentation to minimize the risk of audits and denials.

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 K08.401?

K08.401 covers cases of partial tooth loss without a specified cause, which may include loss due to periodontal disease, trauma, or other dental conditions. It does not specify the underlying etiology, allowing for broader application in cases where the cause is not immediately identifiable.

When should K08.401 be used instead of related codes?

K08.401 should be used when there is partial loss of teeth without a clear cause. If the cause is known, such as periodontal disease or trauma, more specific codes should be utilized to accurately reflect the condition.

What documentation supports K08.401?

Documentation for K08.401 should include a comprehensive dental examination, patient history detailing the onset and progression of tooth loss, radiographic images, and any treatment plans or referrals made. This ensures clarity in diagnosis and supports the coding process.