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ICD-10 Guide
ICD-10 CodesK08.434

K08.434

Billable

Partial loss of teeth due to caries, class IV

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

Code Description

ICD-10 K08.434 is a billable code used to indicate a diagnosis of partial loss of teeth due to caries, class iv.

Key Diagnostic Point:

K08.434 refers to partial loss of teeth due to caries, class IV, which is characterized by significant decay affecting the structure of the teeth. Clinically, this condition presents as visible cavities or holes in the teeth, leading to pain, sensitivity, and potential infection. The anatomy involved primarily includes the enamel, dentin, and pulp of the teeth, which may be compromised due to the progression of caries. Disease progression typically starts with demineralization of the enamel, advancing to deeper layers of the tooth if untreated, potentially resulting in tooth loss. Diagnostic considerations include clinical examination, radiographic imaging to assess the extent of decay, and patient history to identify risk factors such as poor oral hygiene, dietary habits, and systemic conditions that may contribute to caries development. Early detection and intervention are crucial to prevent further deterioration and complications such as abscess formation or systemic infection.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough examination and imaging to determine extent of caries.
  • Treatment complexity: May involve restorative procedures such as fillings, crowns, or extractions.
  • Documentation requirements: Detailed records of clinical findings, treatment plans, and patient history are necessary.
  • Coding specificity: Requires precise coding to differentiate between various classes of caries and their impact.

Audit Risk Factors

  • Common coding errors: Misclassification of caries class or failure to document the extent of loss.
  • Documentation gaps: Incomplete patient history or lack of imaging to support diagnosis.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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

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ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K08.434 lies in its potential to affect oral health and overall quality of life. Partial loss of teeth can lead to difficulties in eating, speaking, and maintaining proper nutrition, impacting population health. Quality measures may include monitoring the prevalence of dental caries and the effectiveness of preventive measures. Understanding the epidemiology of caries can help healthcare providers develop targeted interventions to reduce incidence and improve oral health outcomes.

ICD-9 vs ICD-10

The clinical significance of K08.434 lies in its potential to affect oral health and overall quality of life. Partial loss of teeth can lead to difficulties in eating, speaking, and maintaining proper nutrition, impacting population health. Quality measures may include monitoring the prevalence of dental caries and the effectiveness of preventive measures. Understanding the epidemiology of caries can help healthcare providers develop targeted interventions to reduce incidence and improve oral health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, such as restorative work or extractions. Common denials may arise from insufficient documentation or incorrect coding, emphasizing the need for clear clinical notes and imaging to support claims. Best practices include verifying insurance coverage for dental procedures and ensuring that all necessary documentation is submitted with claims to avoid delays in payment.

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 K08.434?

K08.434 covers partial loss of teeth specifically due to class IV caries, which involves extensive decay affecting the enamel and dentin, potentially reaching the pulp. This classification indicates a severe level of tooth decay that may require significant intervention.

When should K08.434 be used instead of related codes?

K08.434 should be used when there is clear evidence of class IV caries leading to partial tooth loss. It is distinct from other classes of caries, which may not involve as much structural damage or may be in earlier stages of decay.

What documentation supports K08.434?

Documentation for K08.434 should include clinical notes detailing the extent of caries, radiographic images showing the decay, treatment plans, and any relevant patient history that supports the diagnosis of class IV caries.