Current RMA Instruments:
Reasonable Hypothesis SOP | 74 of 2024 |
Balance of Probabilities SOP | 75 of 2024 |
Changes from previous Instruments:
ICD Coding:
- ICD-10-AM Codes: K02.0-K02.3 and K02.8-K02.9
Brief description
Dental caries involves localised destruction of dental hard tissues (enamel, cementum, or dentin) caused by bacteria in dental plaque, leading to demineralisation or cavity formation. Any part of the tooth can develop dental caries, including the crown, neck or root.
Confirming the diagnosis
To establish this diagnosis, a dental report is required.
Additional diagnoses covered by SOP
- Nil
Conditions not covered by SOP
- Dental pulp and periapical disease *
- Periodontitis *
- Loss of teeth/ tooth loss * Loss of teeth
- Tooth wear *
* another SOP applies - the SOP has the same name unless otherwise specified
Clinical onset
Each occurrence of tooth decay/dental caries can be considered as a new clinical onset.
Clinical worsening
The development of new cavities in other locations at later times is a new onset of tooth decay in the affected tooth rather than a case of clinical worsening. Progression of tooth decay to dental pulp disease or loss of a tooth (extraction) is covered under the SOPs for those conditions. The only SoP clinical worsening factor is for inability to obtain appropriate clinical management. Lack of timely treatment of a cavity could lead to worsening of that cavity.