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Dental Pulp and Apical Disease F052

Last amended 
25 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
3 of 2014
Balance of Probabilities SOP
4 of 2014
Changes from Previous Instruments:

SOP Bulletin 171

ICD Coding:
  • ICD-9-CM Codes: 522.0, 522.1, 522.2, 522.5, 522.7, 522.3, 522.4, 522.6, 522.8
  • ICD-10-AM Codes: K44, K04.1, K04.2, K04.6, K04.7, K04.9

Dental pulp disease involves inflammation / infection of the soft inner part of the tooth.  It is this condition for which root canal treatment is required.  The adjacent apex of a tooth may also be involved.

Is specific diagnostic evidence required to apply the SOP?Yes.

This requires an opinion from dentist or copies of the contemporary dental records.

Are there sub-factors that require specific information? – No.
Additional diagnoses covered by SOP
  • Acute and chronic apical periodontitis
  • Apical abscess or endodontic abscess or dentoalveolar abscess.
  • Apical cyst
  • Pulp degeneration
  • Pulp necrosis
  • Pulpitis
Conditions excluded from SOP
  • Combined periodontics-endodontic lesions
  • Chronic periodontitis, ICD 9 code 523.4
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.