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ICD-10 Guide
ICD-10 CodesK08.51

K08.51

Billable

Open restoration margins of tooth

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

Code Description

ICD-10 K08.51 is a billable code used to indicate a diagnosis of open restoration margins of tooth.

Key Diagnostic Point:

K08.51 refers to the condition of open restoration margins of a tooth, which indicates that the margins of a dental restoration, such as a filling or crown, are not adequately sealed against the tooth structure. This can lead to various complications, including recurrent caries, sensitivity, and potential tooth loss. The clinical presentation may include visible gaps at the restoration margins, discomfort during chewing, or increased sensitivity to temperature changes. The anatomy involved primarily includes the enamel, dentin, and pulp of the tooth, as well as the surrounding gingival tissue. Disease progression can occur if the open margins allow bacteria to infiltrate, leading to decay beneath the restoration. Diagnostic considerations include clinical examination, radiographic evaluation, and possibly the use of transillumination to assess the integrity of the restoration. Proper identification and management of this condition are crucial to prevent further dental complications and ensure the longevity of dental restorations.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and imaging to determine the extent of the issue.
  • Treatment complexity: May involve re-evaluation of the restoration, potential replacement, or additional procedures.
  • Documentation requirements: Detailed documentation of clinical findings, treatment rationale, and patient history is necessary.
  • Coding specificity: Requires precise coding to differentiate from other dental conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of the condition or incorrect code assignment.
  • Documentation gaps: Incomplete records that do not support the diagnosis or treatment provided.
  • Billing challenges: Potential denials if documentation does not clearly justify the need for the procedure.

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 K08.51 lies in its potential to lead to further dental complications if not addressed promptly. Open restoration margins can increase the risk of recurrent caries, impacting population health by contributing to higher rates of dental disease. Quality measures may include monitoring the success rates of restorations and patient satisfaction with dental care. Understanding healthcare utilization patterns related to dental restorations can help in resource allocation and improving patient outcomes in dental practices.

ICD-9 vs ICD-10

The clinical significance of K08.51 lies in its potential to lead to further dental complications if not addressed promptly. Open restoration margins can increase the risk of recurrent caries, impacting population health by contributing to higher rates of dental disease. Quality measures may include monitoring the success rates of restorations and patient satisfaction with dental care. Understanding healthcare utilization patterns related to dental restorations can help in resource allocation and improving patient outcomes in dental practices.

Reimbursement & Billing Impact

reimbursement policies can vary significantly among payers.

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 K08.51?

K08.51 specifically covers cases where there are open margins on dental restorations, which can lead to complications such as secondary caries, pulpitis, or tooth fracture. It does not cover conditions related to the tooth structure itself without restoration involvement.

When should K08.51 be used instead of related codes?

K08.51 should be used when there is clear evidence of open restoration margins that necessitate intervention. It should be differentiated from codes that describe other types of dental issues, such as K08.52, which pertains to secondary conditions arising from open margins.

What documentation supports K08.51?

Documentation should include clinical notes detailing the examination findings, radiographic images showing the restoration margins, treatment plans, and any patient-reported symptoms. Comprehensive records are essential for substantiating the diagnosis and treatment.