Oral Surgery Coding & Reimbursement Alert

Question: Can you let me know what diagnosis codes I should use if our oral surgeon is mentioning the diagnosis as dentoalveolar abscess?

Michigan Subscriber

Answer: When reporting a diagnosis of dentoalveolar abscess, periapical or a dental abscess, you will have to look into documentation to check if there is a draining sinus mentioned as your coding choices will depend on this. If no mention of the sinus has been made, query your surgeon.

Depending on the presence or absence of a draining sinus, your coding options using ICD-9 coding system includes:

• 522.5 (Periapical abscess without sinus)
• 522.7 (Periapical abscess with sinus)

If the abscess has spread to the floor of the mouth and caused cellulitis or your surgeon mentions the diagnosis as Ludwig’s Angina (a potentially serious complication), you will have to use other code choices to describe the diagnosis. In such a case, you will have to opt to report 528.3 (Cellulitis and abscess of oral soft tissues) to report the diagnosis.

ICD-10 change: When reporting the diagnosis using ICD-10 codes, you will have to use K04.7 (Periapical abscess without sinus) for a diagnosis of dentoalveolar abscess without a draining sinus and K04.6 (Periapical abscess with sinus) when there is a draining sinus present. You will have to use K12.2 (Cellulitis and abscess of mouth) when your surgeon diagnoses the patient with cellulitis or Ludwig’s Angina.