What ICD (International Classification of Diseases) code can I use for an odontogenic infection?

ICD Coding for Odontogenic Infection

For odontogenic infections, use ICD-10 code K04.7 (Periapical abscess without sinus) for localized dental abscesses, K05.21 (Aggressive periodontitis, localized) for periodontal infections, or K12.2 (Cellulitis and abscess of mouth) for spreading infections involving facial spaces.

Primary ICD-10 Codes for Odontogenic Infections

The appropriate code depends on the specific clinical presentation and anatomical location of the infection 1:

Localized Dental Infections

• K04.7 - Periapical abscess without sinus: Use this for infections originating from pulpal necrosis or apical periodontitis, which represents the most common origin (46.9% of cases) 1, 2
• K04.6 - Periapical abscess with sinus: Use when a draining fistula is present 1
• K05.21 - Aggressive periodontitis, localized: For infections arising from periodontal disease 3

Spreading or Complex Infections

• K12.2 - Cellulitis and abscess of mouth: Use for infections extending beyond the tooth apex into fascial spaces (submandibular, sublingual, parapharyngeal, retropharyngeal) 3
• K10.2 - Inflammatory conditions of jaws: For osteomyelitis or infections involving bone 1

Post-Procedural Infections

• K08.89 - Other specified disorders of teeth and supporting structures: Consider for infections following tooth extraction (25.8% of odontogenic infections) 2

Pericoronitis

• K05.22 - Acute pericoronitis: For infections around partially erupted teeth (6.0% of cases) 2

Clinical Context for Code Selection

The most frequently affected teeth are the maxillary and mandibular first molars, which should guide your documentation 1. When coding, specify:

• Location: Document whether infection involves maxillary or mandibular teeth 1
• Extent: Note if infection is localized (infiltrate) or has progressed to abscess formation (approximately 50% of cases present as abscesses) 1
• Complications: If infection has spread to deep fascial spaces, use K12.2 rather than K04.7 3

Important Coding Considerations

Multiple Infectious Foci

When patients present with multiple sites of infection (8.6% of cases), code each site separately or use K12.2 for diffuse involvement 2.

Systemic Complications

If odontogenic infection has caused systemic manifestations, add secondary codes 4:

• I33.0 - Acute and subacute infective endocarditis (for cardiac valve involvement)
• G06.0 - Intracranial abscess (for intracranial spread)
• J85.1 - Abscess of lung with pneumonia (for pulmonary complications)
• I80.8 - Phlebitis and thrombophlebitis of other sites (for septic jugular vein thrombophlebitis/Lemierre syndrome) 3

Comorbidities Affecting Management

Document relevant comorbidities that influence infection severity, particularly diabetes mellitus, which significantly impacts outcomes 5, 2.

Common Pitfalls to Avoid

• Don't use codes for simple dental caries (K02.x) when active infection is present - these are inadequate for billing and don't reflect the severity 1
• Avoid using unspecified codes (K04.9) when clinical examination can determine the specific type of infection 1
• Don't overlook airway compromise coding - if respiratory distress is present, add J96.0 (Acute respiratory failure) as this affects reimbursement and reflects severity 6, 7
• Remember that 34.3% of patients receive no antibiotics before hospitalization - document whether this is initial presentation or treatment failure, as this affects coding for subsequent encounters 2