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Dental Caries F007
In this section
Current RMA Instruments:
|Reasonable Hypothesis SOP||122 of 2015|
|Balance of Probabilities SOP||123 of 2015|
Changes from previous Instruments:
- ICD-9-CM Codes: 521.0
- ICD-10-AM Codes: K02.0-K02.3 and K02.8-K02.9
Dental caries is tooth decay and cavity formation.
Confirming the diagnosis
Diagnosis will be based on a report from a dentist.
Additional diagnoses covered by SOP
Conditions not covered by SOP
- Dental pulp and apical disease*
- Loss of teeth*
* another SOP applies - the SOP has the same name unless otherwise specified
Each occurence of dental caries can be considered as a new clinical onset and claims can be determined on a cavity by cavity, or episode by episode basis.
Development of new cavities in other locations at later times is a new onset of dental caries in the affected tooth rather than worsening of dental caries. Progression of caries to dental pulp disease or loss of a tooth (extraction) is covered under the SOPs for those conditions. The only SOP worsening factor is for inability to obtain appropriate clinical managment. Lack of timely treatment of a cavity could lead to worsening of that cavity.