ICD-10 Coding for Tooth Abscess(K04.6, K04.7)
Complete ICD-10-CM coding and documentation guide for Tooth Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tooth Abscess
K04.6-K04.7Primary Range
Disorders of pulp and periapical tissues
This range includes codes specific to periapical abscesses with and without sinus involvement.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K04.6 | Periapical abscess with sinus | Use when a sinus tract is present with the abscess. |
|
| K04.7 | Periapical abscess without sinus | Use when no sinus tract is present with the abscess. |
|
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 tooth abscess with sinus
Essential facts and insights about Tooth Abscess
Primary ICD-10-CM Codes for tooth abscess
Decision Criteria
clinical Criteria
- Sinus tract observed clinically or via imaging
Applicable To
- Periapical abscess with sinus tract
Excludes
- Gingival abscess (K05.6)
Clinical Validation Requirements
- Presence of draining sinus tract
- Imaging showing lesion extending to sinus
Code-Specific Risks
- Misidentifying the presence of a sinus tract
Coding Notes
- Ensure documentation specifies the presence of a sinus tract.
K04.7 - Periapical abscess without sinus
Use when no sinus tract is present with the abscess.
Applicable To
- Periapical abscess without sinus tract
Excludes
- Gingival abscess (K05.6)
Clinical Validation Requirements
- Absence of sinus tract
- Imaging showing localized periapical lesion
Coding Notes
Ensure documentation confirms the absence of a sinus tract.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Incision and drainage of abscess
D7510Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Tooth Abscess to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K04.6.
Impact
Clinical: Misdiagnosis of abscess type, Regulatory: Potential audit triggers, Financial: Claim denials or reduced reimbursement
Mitigation Strategy
Use standardized templates, Cross-check documentation with imaging
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Verify and document the presence or absence of a sinus tract.
Impact
Lack of documentation for sinus tract presence can lead to audits.
Mitigation Strategy
Ensure thorough documentation and imaging confirmation.
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 Tooth Abscess, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tooth Abscess
Use these documentation templates to ensure complete and accurate documentation for Tooth Abscess. These templates include all required elements for proper coding and billing.
Endodontic Treatment of Abscess
Specialty: DentistryRequired Elements
- Tooth number
- Presence of sinus tract
- Imaging findings
- Pulp vitality test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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