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ICD-10 Guide
ICD-10 CodesK08.531

K08.531

Billable

Fractured dental restorative material with loss of material

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

Code Description

ICD-10 K08.531 is a billable code used to indicate a diagnosis of fractured dental restorative material with loss of material.

Key Diagnostic Point:

K08.531 refers to fractured dental restorative material with loss of material, which typically occurs in patients with existing dental restorations such as crowns, bridges, or fillings. Clinically, this condition may present with symptoms including sensitivity to temperature, pain during chewing, or visible damage to the restoration. The anatomy involved primarily includes the tooth structure and the restorative material, which may be composite resin, amalgam, or porcelain. Disease progression can vary; if left untreated, a fractured restoration may lead to further tooth decay, pulpitis, or even tooth loss. Diagnostic considerations include clinical examination, radiographic evaluation, and patient history to assess the extent of the fracture and any associated symptoms. Proper diagnosis is crucial to determine the appropriate treatment plan, which may involve repair or replacement of the restorative material.

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 or the nature of the fracture.
  • Documentation gaps may arise if the clinical notes do not clearly describe the fracture and its implications.
  • Billing challenges can occur if the treatment plan is not well-documented or if the restoration's failure is not adequately justified.

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 K08.531 lies in its potential to lead to further dental complications if not addressed promptly. Population health impact includes the prevalence of dental restorations and the likelihood of fractures occurring, which can affect overall oral health. Quality measures may focus on the timely repair of fractured restorations to prevent further decay or tooth loss. Healthcare utilization patterns may show increased visits to dental professionals for repairs, highlighting the importance of preventive care and patient education regarding the maintenance of dental restorations.

ICD-9 vs ICD-10

The clinical significance of K08.531 lies in its potential to lead to further dental complications if not addressed promptly. Population health impact includes the prevalence of dental restorations and the likelihood of fractures occurring, which can affect overall oral health. Quality measures may focus on the timely repair of fractured restorations to prevent further decay or tooth loss. Healthcare utilization patterns may show increased visits to dental professionals for repairs, highlighting the importance of preventive care and patient education regarding the maintenance of dental restorations.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for dental procedures and ensuring that the treatment plan aligns with the diagnosis. Common denials may occur if the documentation does not adequately justify the need for repair or replacement of the restoration. Best practices include thorough documentation of the clinical findings, treatment rationale, and any patient complaints related to the fractured restoration.

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 K08.531?

K08.531 specifically covers cases where dental restorative materials have fractured and resulted in loss of material, which can include crowns, fillings, or other types of restorations. It is important to document the specific type of restoration and the extent of the fracture.

When should K08.531 be used instead of related codes?

K08.531 should be used when there is clear evidence of a fracture in the dental restorative material with loss of material. It is distinct from codes for dental caries or other conditions where the restoration is intact or not compromised.

What documentation supports K08.531?

Documentation should include clinical notes detailing the patient's symptoms, the examination findings, radiographic evidence of the fracture, and any treatment plans proposed. Clear descriptions of the type of restorative material and the nature of the fracture are essential.