ICD-10 Coding for Periodontal Disease(K05.3, K05.1)
Complete ICD-10-CM coding and documentation guide for Periodontal Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Periodontal Disease
K05.0-K05.6Primary Range
Diseases of the gingiva and periodontium
This range includes all forms of gingivitis and periodontitis, which are the primary conditions under periodontal disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K05.3 | Chronic periodontitis | Use when there is evidence of chronic periodontitis with bone loss and clinical attachment loss. |
|
| K05.1 | Chronic gingivitis | Use when there is chronic gingival inflammation without evidence of bone loss. |
|
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 chronic periodontitis
Essential facts and insights about Periodontal Disease
Primary ICD-10-CM Codes for periodontal disease
Decision Criteria
clinical Criteria
- Presence of chronic inflammation with bone loss
Applicable To
- Chronic periodontitis, generalized
- Chronic periodontitis, localized
Excludes
- Aggressive periodontitis (K05.2)
Clinical Validation Requirements
- Probing depths ≥4mm
- Clinical attachment loss ≥2mm
- Radiographic bone loss ≥15% root length
Code-Specific Risks
- Ensure documentation supports chronic nature and severity.
Coding Notes
- Chronic periodontitis codes should reflect the severity and extent of the disease.
K05.1 - Chronic gingivitis
Use when there is chronic gingival inflammation without evidence of bone loss.
Applicable To
- Chronic gingivitis with inflammation
Excludes
- Acute gingivitis (K05.0)
Clinical Validation Requirements
- Gingival inflammation without bone loss
Coding Notes
Ensure documentation clearly differentiates from periodontitis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of nicotine dependence
Z87.891Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Periodontal Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K05.3.
Impact
Clinical: Inaccurate assessment of disease progression., Regulatory: Potential audit failures., Financial: Denied claims due to insufficient documentation.
Mitigation Strategy
Ensure comprehensive periodontal charting., Include radiographic evidence where applicable.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use D4910 for periodontal maintenance if post-SRP; D4341/D4342 if active disease.
Impact
Incomplete documentation can lead to audit failures.
Mitigation Strategy
Ensure complete periodontal charting and radiographic evidence are included.
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 Periodontal Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Periodontal Disease
Use these documentation templates to ensure complete and accurate documentation for Periodontal Disease. These templates include all required elements for proper coding and billing.
Post-SRP Visit
Specialty: DentistryRequired Elements
- Assessment of periodontal status
- Plan for periodontal maintenance
- Patient education on oral hygiene
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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