ICD-10 Coding for Oral Infection(K04.7, K04.6)
Complete ICD-10-CM coding and documentation guide for Oral Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Oral Infection
K04.0-K04.9Primary Range
Diseases of pulp and periapical tissues
This range includes codes for various oral infections affecting the pulp and periapical tissues.
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 sinus involvement. |
|
| K04.6 | Periapical abscess with sinus | Use when a periapical abscess extends into the sinus. |
|
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 periapical abscess without sinus
Essential facts and insights about Oral Infection
Primary ICD-10-CM Codes for oral infection
Decision Criteria
clinical Criteria
- Absence of sinus involvement
Applicable To
- Periapical abscess
Excludes
- Periapical abscess with sinus involvement (K04.6)
Clinical Validation Requirements
- Localized swelling
- Percussion pain
- Periapical radiolucency on X-ray
Code-Specific Risks
- Incorrectly coding as with sinus involvement could lead to denials.
Coding Notes
- Ensure documentation specifies absence of sinus involvement.
K04.6 - Periapical abscess with sinus
Use when a periapical abscess extends into the sinus.
Applicable To
- Periapical abscess with sinus involvement
Excludes
- Periapical abscess without sinus involvement (K04.7)
Clinical Validation Requirements
- Sinus pain
- Purulent nasal discharge
- Radiographic sinus opacification
Coding Notes
Document sinus involvement clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute sinusitis
J01.90Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Oral 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: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific terminology., Include diagnostic test results.
Impact
Reimbursement: May result in reduced reimbursement if not coded correctly., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of patient condition.
Mitigation Strategy
Add J01.90 as a secondary code when sinus involvement is present.
Impact
Failure to document sinus involvement can lead to incorrect coding.
Mitigation Strategy
Ensure imaging and clinical findings are documented.
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 Oral Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Oral Infection
Use these documentation templates to ensure complete and accurate documentation for Oral Infection. These templates include all required elements for proper coding and billing.
Periapical abscess with systemic symptoms
Specialty: DentistryRequired Elements
- Chief complaint
- Objective findings
- Radiographic evidence
- Diagnosis
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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