The K04.7 diagnosis code, as defined within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), is a crucial tool for dental professionals and medical coders. This code specifically identifies a periapical abscess without sinus, a common yet significant dental condition. Understanding the intricacies of the K04.7 code is essential for accurate diagnosis, treatment planning, and medical billing within the healthcare system.
Decoding K04.7: Periapical Abscess Without Sinus
K04.7 is a billable and specific code, meaning it is recognized for reimbursement purposes and precisely pinpoints a particular condition. The code officially came into effect on October 1, 2024, with the 2025 edition of ICD-10-CM, and it’s the American adaptation of the international ICD-10 K04.7, which may have slight variations across different countries.
This diagnosis code is applicable to and synonymous with several terms commonly used in dentistry, including:
- Dental abscess without sinus
- Dentoalveolar abscess without sinus
- Dental abscess
- Dental infection
- Infection of tooth
- Periapical abscess
- Periapical abscess without sinus tract
These terms all essentially describe an infection at the tip of the tooth root (periapical area) that has not created an opening or pathway (sinus tract) to drain externally.
Significance and Context of the K04.7 Code
Within the broader ICD-10-CM classification, K04.7 falls under the category of “Diseases of pulp and periapical tissues” (K04), which is part of “Diseases of the oral cavity, salivary glands and jaws” (K00-K14). This hierarchical structure helps in systematically categorizing and coding various dental conditions.
The K04.7 code is situated adjacent to other related codes, such as K04.6 “Periapical abscess with sinus,” highlighting the subtle yet important distinction based on the presence or absence of a sinus tract. Understanding these adjacent codes provides a comprehensive view of periapical abscesses and their variations.
Furthermore, K04.7 is relevant to Diagnostic Related Groups (MS-DRG v42.0), which are used for classifying hospital cases and determining reimbursement rates. This connection underscores the importance of accurate K04.7 coding in healthcare administration and financial processes.
Historical Overview and Consistent Application
Since its introduction as a new code in 2016 (effective October 1, 2015), K04.7 has remained unchanged through the annual ICD-10-CM updates, including the 2025 edition. This stability indicates the code’s consistent and reliable application in medical coding and diagnostics over the years. The continuous use of K04.7 reinforces its value as a standard and recognized code for “Periapical abscess without sinus” in the medical field.
In conclusion, the K04.7 diagnosis code is a vital component of the ICD-10-CM system for accurately identifying and classifying periapical abscesses without sinus. Its specific nature, clear applicability, and consistent use make it indispensable for dental professionals, medical coders, and healthcare administrators in ensuring precise diagnoses, effective treatment, and appropriate medical billing practices.
