Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDiseases of oral cavity and salivary glandsICD-10-CM k04-diseases-of-pulp-and-periapical-tissues
    Ask Trek AI about this page

    ICD-10-CM Code For Diseases Of Pulp And Periapical Tissues: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group K04 includes diagnoses for inflammatory, infectious, and necrotic conditions of the dental pulp and periapical tissues, such as pulpitis, pulp necrosis, and periapical abscesses. These ICD-10-CM diagnosis codes are used to document clinical encounters involving tooth pain, endodontic disease, root canal therapy, and complications affecting periapical structures, capturing disease severity and treatment complexity. Accurate coding within the ICD-10-CM K04 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Diseases Of Pulp And Periapical Tissues: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM K04: Diseases Of Pulp And Periapical Tissues Overview

    The ICD-10-CM K04 group includes diagnoses related to inflammation, infection, necrosis, and other pathologic conditions of the dental pulp and the periapical tissues surrounding tooth roots. These conditions affect the oral cavity and can lead to pain, tooth loss, or spread of infection if untreated. Accurate coding is important for complete clinical documentation and appropriate reimbursement for dental and related medical services.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when a patient presents with clinical or diagnostic findings indicating disease of the pulp or periapical tissues, such as pain, swelling, radiographic periapical radiolucency, or documented pulp necrosis. Select the code that matches the documented acuity, laterality if specified, and any associated complications to reflect clinical complexity.

    ICD-10-CM Codes

    12 rows

    ICD-10-CM CodeDescription
    K04.01Reversible pulpitis
    K04.02Irreversible pulpitis
    K04.1Necrosis of pulp
    K04.2Pulp degeneration
    K04.3Abnormal hard tissue formation in pulp
    K04.4Acute apical periodontitis of pulpal origin
    K04.5Chronic apical periodontitis
    K04.6Periapical abscess with sinus
    K04.7Periapical abscess without sinus
    K04.8Radicular cyst
    K04.90Unspecified diseases of pulp and periapical tissues
    K04.99Other diseases of pulp and periapical tissues

    DRG Codes

    6 rows

    DRG CodeDescription
    011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
    012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
    013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
    157Dental and Oral Diseases with MCC
    158Dental and Oral Diseases with CC
    159Dental and Oral Diseases without CC/MCC

    Typical Clinical Scenarios

    • A young adult presents to the emergency dental clinic with severe, throbbing tooth pain, facial swelling localized to the involved tooth, fever, and difficulty sleeping after a rapidly worsening toothache over 48 hours. Examination reveals tenderness to percussion, a large carious lesion with pulpal exposure, and a periapical radiolucency on radiograph consistent with acute infection; an urgent pulpectomy or extraction is planned and an endodontic-periapical diagnosis from this group is assigned. Typical codes: K04.0, K04.4.
    • A middle-aged patient attends routine dental follow-up for persistent, low-grade discomfort and intermittent sinus tract drainage adjacent to a previously root-treated molar; radiographs show a chronic periapical radiolucency with no systemic signs. Because the presentation is long-standing with evidence of chronic periapical pathology related to the pulp, a chronic pulpal/periapical diagnosis from this group is recorded to guide retreatment or surgical management. Typical codes: K04.1, K04.2.
    • An older patient with poorly controlled diabetes is hospitalized after developing spreading cellulitis originating from a necrotic tooth with periapical abscess and signs of systemic involvement; the tooth requires extraction and the patient needs intravenous antibiotics and close monitoring. Given the tooth necrosis with periapical abscess and complication of systemic infection in a medically compromised host, an acute periapical disease code from this group is assigned to capture the infectious complication. Typical codes: K04.7, K04.8.

    Related Codes

    K00-DISORDERS-OF-TOOTH-DEVELOPMENT-AND-ERUPTION

    ICD-10-CM Code For Disorders Of Tooth Development And Eruption: Group Overview

    K01-EMBEDDED-AND-IMPACTED-TEETH

    ICD-10-CM Code For Embedded And Impacted Teeth: Group Overview

    K02-DENTAL-CARIES

    ICD-10-CM Code For Dental Caries: Group Overview

    K03-OTHER-DISEASES-OF-HARD-TISSUES-OF-TEETH

    ICD-10-CM Code For Other Diseases Of Hard Tissues Of Teeth: Group Overview

    K05-GINGIVITIS-AND-PERIODONTAL-DISEASES

    ICD-10-CM Code For Gingivitis And Periodontal Diseases: Group Overview

    K06-OTHER-DISORDERS-OF-GINGIVA

    ICD-10-CM Code For Other Disorders Of Gingiva And Edentulous Alveolar Ridge: Group Overview

    K08-OTHER-DISORDERS-OF-TEETH

    ICD-10-CM Code For Other Disorders Of Teeth And Supporting Structures: Group Overview

    K09-CYSTS-OF-ORAL-REGION

    ICD-10-CM Code For Cysts Of Oral Region Not Elsewhere Classified: Group Overview

    K11-DISEASES-OF-SALIVARY-GLANDS

    ICD-10-CM Code For Diseases Of Salivary Glands: Group Overview

    K12-STOMATITIS-AND-RELATED-LESIONS

    ICD-10-CM Code For Stomatitis And Related Lesions: Group Overview

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.