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2025 ICD-10-CM code K05.01

Acute gingivitis not caused by plaque.

Follow official ICD-10-CM coding guidelines and conventions.

Medical necessity is established when clinical findings demonstrate acute gingival inflammation without plaque as the primary causative agent.The documentation should support the diagnosis, ruling out other conditions.Further investigation into the etiology may be medically necessary.

Diagnosis and treatment of gingival inflammation; assessment for underlying causes; patient education on oral hygiene.

IMPORTANT:Consider K05.0 (Gingivitis) if the etiology is uncertain.Excludes acute necrotizing ulcerative gingivitis (A69.1) and herpesviral gingivostomatitis (B00.2).

In simple words: This code is for gum inflammation (gingivitis) that isn't caused by plaque (the sticky film on teeth).Your gums might be red, swollen, and bleed easily, but this isn't due to plaque buildup.

This code classifies acute gingivitis that is not induced by plaque.It is a type of gum inflammation characterized by redness, swelling, and bleeding of the gums, but without the presence of plaque buildup as the primary cause.Further investigation may be needed to determine the underlying etiology.

Example 1: A 25-year-old presents with red, swollen gums and bleeding upon brushing.No significant plaque is observed.K05.01 is coded after a thorough examination rules out other causes such as infections or medication side effects., A 50-year-old with a history of poorly controlled diabetes presents with gingival inflammation.While some plaque is present, the severity of the inflammation suggests other contributing factors. After considering other causes, K05.01 is coded., A 10-year-old presents with gingivitis.The child has excellent oral hygiene with minimal plaque.After ruling out underlying causes, K05.01 is coded.Additional codes may be necessary to document other contributing factors or comorbidities.

Detailed clinical examination of the gingiva; assessment of plaque levels;documentation of any systemic conditions;relevant diagnostic tests, if performed;treatment plan and response to therapy.

** This code should be used cautiously and only when plaque is not considered the primary cause of the gingivitis.A comprehensive evaluation is crucial to rule out other diagnoses.

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