Dental Pulp and Periapical Disease F052

Current RMA Instruments

Changes from previous Instruments

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

Brief description

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.

Confirming the diagnosis

Diagnosis requires an opinion from a dentist or copies of contemporary dental records.

Additional diagnoses covered by SOP

• Abnormal hard tissue formation in pulp, including condensing osteitis
• Acute and chronic apical periodontitis
• Apical/periapical abscess or endodontic abscess or dentoalveolar abscess.
• Apical/periapical cyst
• Periapical periodontitis
• Pulp degeneration
• Pulp necrosis
• Pulp stones
• Pulpitis

Conditions excluded from SOP

• Combined periodontic-endodontic lesions^#
• Chronic periodontitis*
• Peri-implantitis^#
• Periapical lesions that are not of inflammatory origin^#

* another SOP applies

^# non-SOP condition

Clinical onset

Time of clinical onset should be based on advice from the treating dentist.

Clinical worsening

The presence of clinical worsening beyond the normal course of the disease should be determined based on advice from a dentist.