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ICD-10 Guide
ICD-10 CodesK08.53

K08.53

Non-billable

Fractured dental restorative material

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

Code Description

ICD-10 K08.53 is a used to indicate a diagnosis of fractured dental restorative material.

Key Diagnostic Point:

K08.53 refers to fractured dental restorative material, which can occur in various forms of dental restorations such as crowns, bridges, fillings, and dentures. Clinically, this condition may present with symptoms including pain, sensitivity, or visible damage to the restoration. The anatomy involved primarily includes the teeth and surrounding structures, such as the gums and jawbone. The progression of this condition can lead to further complications, including decay of the underlying tooth structure, infection, or the need for more extensive dental procedures. Diagnostic considerations for K08.53 involve clinical examination, radiographic imaging, and patient history to assess the extent of the fracture and its impact on oral health. Treatment may vary from simple repair or replacement of the restorative material to more complex interventions depending on the severity of the fracture and the condition of the underlying tooth.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misidentifying the type of restoration involved.
  • Documentation gaps may arise if the extent of damage is not clearly described.
  • Billing challenges can occur if the treatment provided does not match the documented 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 K08.53 lies in its potential to affect oral health and overall quality of life. Fractured dental restorations can lead to pain, infection, and further dental complications, impacting population health. Quality measures may include tracking the incidence of restorative failures and patient satisfaction with dental care. Understanding healthcare utilization patterns related to this condition can help in resource allocation and improving patient outcomes.

ICD-9 vs ICD-10

The clinical significance of K08.53 lies in its potential to affect oral health and overall quality of life. Fractured dental restorations can lead to pain, infection, and further dental complications, impacting population health. Quality measures may include tracking the incidence of restorative failures and patient satisfaction with dental care. Understanding healthcare utilization patterns related to this condition can help in resource allocation and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for dental procedures and ensuring that the treatment aligns with the documented diagnosis. Common denials may arise from insufficient documentation or mismatched codes. Best practices include thorough clinical notes, accurate coding, and pre-authorization when necessary to minimize billing challenges.

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 K08.53?

K08.53 covers conditions related to the fracture of dental restorative materials, including crowns, bridges, fillings, and dentures. It specifically addresses cases where the integrity of the restoration is compromised, leading to potential complications.

When should K08.53 be used instead of related codes?

K08.53 should be used when the primary issue is the fracture of the restorative material itself, rather than the underlying tooth structure. If the tooth is also fractured, a different code may be more appropriate.

What documentation supports K08.53?

Documentation for K08.53 should include clinical notes detailing the type of restorative material, the nature of the fracture, any symptoms experienced by the patient, and the treatment plan proposed or executed.