We saw a patient that was having tooth pain caused by an abscess due to fracture of restorative material and tooth structure. Tooth #30 had undergone a root canal and large filling many years ago. It is possible there was residual pulpal tissue as radiographic evaluation shows endo fill not to apex.

Dr. diagnosed the cause as broken down restoration due to decay and fracture leading to irreversible pulpitis, periapical abscess. The tooth was determined un-restorable. ICD codes we are thinking would include periapical abscess without sinus (ICD K04.7), irreversible pulpitis (ICD K04.02), fractured dental restorative material with loss of material (ICD K08.531) and caries (ICD K02.9).

We had a question on the fracture ICD code, it is still appropriate to use S02.5XXA if the fracture was not caused by an accident or traumatic event? Is there another fracture code that would be more appropriate in this case? Or are we ok to just use the fractured dental restorative material with loss of material (ICD K08.531)? The patient’s dental insurance specifies to bill medical insurance for oral surgery first before billing dental.

The tooth was surgically extracted (CDT D7210) so we are going to report the dental extraction code on the medical insurance claim form.

Also, is there a resource we can use to get more specific information and definitions of ICD codes?

Thank you.