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Home/Diagnosis/ICD-10 Coding for Oral Abscess

ICD-10 Coding for Oral Abscess

K04.6
K04.7
K12.2

Complete ICD-10-CM coding and documentation guide for icd-10 coding for oral abscess includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Mouth Abscess
Dental Abscess
Periapical Abscess
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Key Information: ICD-10 Coding for Oral Abscess

Essential facts and insights about ICD-10 Coding for Oral Abscess

Use ICD-10 code K04.6 for periapical abscess with sinus, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Periapical abscess with sinus

Billable Code
K04.6
Billable

Diagnostic Criteria

  • • Presence of a sinus tract confirmed by imaging

Applicable To

  • • Periapical abscess with fistula

Important Notes

  • • Ensure documentation specifies the presence of a sinus tract.

Periapical abscess without sinus

Billable Code
K04.7
Billable

Diagnostic Criteria

  • • Localized swelling and tenderness without sinus tract
  • • Radiographic evidence of periapical radiolucency

Applicable To

  • • Localized fluctuant swelling without drainage

Important Notes

  • • Document absence of sinus tract clearly.

Cellulitis and abscess of oral soft tissues

Billable Code
K12.2
Billable

Diagnostic Criteria

  • • Abscess in oral soft tissue not related to dental origin
  • • Confirmed by clinical examination and imaging

Applicable To

  • • Buccal space abscess

Important Notes

  • • Ensure non-dental origin is documented.
Ancillary Codes

Additional codes that may be used with this diagnosis

Z01.21

Encounter for dental examination with abnormal findings

Use when an abscess is discovered during a routine dental exam.

Frequently Asked Questions

What is the ICD-10 code for an oral abscess?

The ICD-10 codes for oral abscesses are K04.6 for periapical abscess with sinus and K04.7 for periapical abscess without sinus.

How do you code a dental abscess with a sinus tract?

For a dental abscess with a sinus tract, use ICD-10 code K04.6. Ensure documentation includes confirmation of the sinus tract.

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