ICD-10 Coding for Dental Infection(K04.7, K04.6)
Complete ICD-10-CM coding and documentation guide for Dental Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dental Infection
K04.6-K04.7Primary Range
Diseases of pulp and periapical tissues
This range includes codes for periapical abscesses with and without sinus tract, which are common manifestations of dental infections.
Encounter for dental examination and cleaning
These codes are used for dental examinations where infections may be incidentally found.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K04.7 | Periapical abscess without sinus | Use when a periapical abscess is confirmed without a sinus tract. |
|
| K04.6 | Periapical abscess with sinus | Use when a periapical abscess is confirmed with a sinus tract. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for dental infection
Essential facts and insights about Dental Infection
Primary ICD-10-CM Codes for dental infection
Decision Criteria
clinical Criteria
- Absence of sinus tract on examination
Applicable To
- Periapical abscess without sinus tract
Excludes
- Periapical abscess with sinus tract (K04.6)
Clinical Validation Requirements
- Percussion sensitivity
- Periapical radiolucency ≥3mm
Code-Specific Risks
- Risk of undercoding if sinus tract is present but not documented.
Coding Notes
- Ensure documentation specifies absence of sinus tract.
K04.6 - Periapical abscess with sinus
Use when a periapical abscess is confirmed with a sinus tract.
Applicable To
- Periapical abscess with sinus tract
Excludes
- Periapical abscess without sinus tract (K04.7)
Clinical Validation Requirements
- Sinus tract visualized
- Purulent discharge
Coding Notes
Document presence of sinus tract clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dental Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K04.7.
Impact
Clinical: Inaccurate localization of infection., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to incomplete documentation.
Mitigation Strategy
Always document tooth number and location., Use templates that prompt for this information.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use K04.6 when a sinus tract is documented.
Impact
High denial rates for K04.6 without documented sinus tract.
Mitigation Strategy
Ensure all clinical notes include sinus tract details when present.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Dental Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dental Infection
Use these documentation templates to ensure complete and accurate documentation for Dental Infection. These templates include all required elements for proper coding and billing.
Emergency visit for dental abscess
Specialty: DentistryRequired Elements
- Subjective: Pain description
- Objective: Swelling, fever
- Assessment: Abscess type
- Plan: Treatment and follow-up
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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