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Difference in Coding Dentoalveolar Codes in ICD-10-CM

July 10th, 2012

ICD-10-CM requires preparation and practice due to its increased specificity levels. In ICD-9-CM, codes pertaining to the Dentoalveolar region are dispersed throughout chapter 9 which reports "Diseases of the Digestive system". Most of the ICD-9-CM dentoalveolar coding throughout chapter 9 is directly cross walked to an ICD-10-CM code with the exception of a few.

  • Category 521 (Dental Caries): ICD-10-CM coding requires the more specific mention of whether the caries is limited to the enamel, dentin, or pulp. (See chart below)
  • Category 525 (Edentulous): ICD-10-CM coding requires the more specific mention of the patient's class of edetulism.

In ICD-10-CM, the majority of the Dentoalveolar codes will now be located within chapters 11 and chapter 13. Also, coding professionals will have to be aware of different modifications and guidelines presented in the new chapters of ICD-10-CM. Some of those guidelines are:

  • Many of the ICD-10-CM categories have added a note for a necessary additional code to further specify the diagnosis. An example of a dentoalveolar code with an additional code needed would be:
  • K05 (523.00) Gingivitis and Periodontal Diseases

    Use additional code to identify:
    Alcohol abuse and dependence (F10-)
    Exposure to environmental tobacco smoke (Z77.22)
    Exposure to tobacco smoke in the prenatal period (P96.81)
    History of tobacco use (Z87.891)
    Occupational exposure to environmental tobacco smoke (Z57.31)
    Tobacco dependence (F17-)
    Tobacco use (Z72.0)

  • Identification of episode of care: ICD-10-CM will require the use of a seventh character in coding instances such as dentoalveolar fractures. This seventh character will identify the patient's encounter of care as follows:
  • Initial encounter for fracture
  • Subsequent encounter for fracture with routine healing
  • Subsequent encounter for fracture with delayed healing
  • Subsequent encounter for fracture with nonunion
  • Subsequent encounter for fracture with mal-union
  • Sequela

ICD-9-CM

ICD-10-CM

802.39

Open fracture of multiple sites of mandible

S02.600_
(Requires 7th character to denote encounter)

Fracture of unspecified part of body of mandible

Note: This ICD-10-CM code is only one example that could crosswalk from the above ICD-9-CM code. Reference the ICD-10-CM Mappings manual for all ICD-10-CM crosswalk coding.

  • Reorganization of codes: Several codes from various chapters in ICD-9-CM were moved to chapter 13 in ICD-10-CM because the codes focus on the musculoskeletal system.

The chart below is an example of a patient who has dental caries. The ICD-9-CM coding of dental caries is much less specific with just one code to describe the diagnosis. When referencing the alphabetical index in both the ICD-9-CM and ICD-10-CM manual locate the category "Caries" then sub-category "dental". The alphabetical index should always be referenced first in determining the proper diagnosis code. However, in ICD-10-CM a simple dictation of "dental caries" in the patient's chart will not be enough to select the proper diagnosis code. The example below demonstrates how ICD-10-CM forces the doctor to use much more specificity and detail within the patient's record to allow for coding the proper ICD-10-CM code.

ICD-9-CM

ICD-10-CM

521.06

Dental caries pit and fissure

K02.51

Dental caries on pit and fissure surface limited to enamel

K02.52

Dental caries on pit and fissure surface penetrating into dentin

K02.53

Dental caries on pit and fissure surface penetrating into pulp

Note: This ICD-10-CM crosswalk code is only one example that is OMS related. Reference the ICD-10-CM Mappings manual for all ICD-10-CM crosswalk coding. To obtain a copy of this manual visit the OptumInsight (formerly Ingenix) website at http://www.optuminsight.com/.

For more information on ICD-10-CM and all of its changes, watch the ICD-10-CM and Coding and Billing Workshops pages of the AAOMS web site for information on educational offerings.