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Gingivitis F009

Last amended 
29 June 2015

In this section

Current RMA Instruments:
Reasonable Hypothesis SOP
45 of 2013
Balance of Probabilities SOP
46 of 2013
Changes from Previous Instruments:

SOP Bulletin 166

ICD Coding:
  • ICD-9-CM Codes: 101, 523.0, 523.1
  • ICD-10-AM Codes: A69.1, K05.0, K05.1

This is inflammation of the gums (also known as the gingiva). This SOP does not extend to inflammation of the deeper supporting structures of the tooth, which is covered by the SOP for periodontitis.

Is specific diagnostic evidence required to apply the SOP?No.

The relevant medical specialist is a dentist or oral surgeon.

Are there sub-factors that require specific information? – Yes.

Smoking and nutritional deficiency factors apply to acute necrotising ulcerative gingivitis only, so information on whether this type of gingivitis is present may be needed. However, this condition is very unlikely to be present.

Additional diagnoses covered by SOP
  • Acute gingivitis
  • Acute necrotising ulcerative gingivitis, also known as trench mouth or Vincent’s gingivitis
  • Chronic gingivitis
  • Desquamative gingivitis
  • Gingival abscess
  • Linear gingival erythema
  • Peri-implant mucositis
  • Plasma cell gingivitis
  • Vincent’s angina
Conditions excluded from SOP
  • Acute periodontitis, obsolete term, either ICD-9-CM code 522.4, 523.3 or 523.9
  • Chronic periodontitis, ICD-9-CM code 523.4
  • Gingival hyperplasia and overgrowth, ICD-9-CM code, 523.8
  • Gingival recession, ICD-9-CM code 523.2
  • Oral aphthae, ICD-9-CM code, 528.2
  • Pericoronal abscess, use ICD code 523.9
  • Pericoronitis (acute or chronic), use ICD-9-CM code 523.9
  • Primary herpetic gingivostomatitis, ICD-9-CM code, 054.2
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then:

  1. seek medical officer advice about further investigation, or;
  2. generate a diagnostic report, or;
  3. re-encode the condition, if appropriate.

The following investigations may be useful in establishing the diagnosis.

  • Report from a dentist.