K04.6 vs K05.2
K04.6 and K05.2 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on K05.2
periapical abscess with sinus (K04.6)
K04.6
Periapical abscess with sinus
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Use when the record says
- Dental abscess with sinus
- Dentoalveolar abscess with sinus
Indexed under
- Fistula › alveolar process (cutaneous)
- Fistula › dental (cutaneous)
- Fistula › from periapical abscess (cutaneous)
- Gumboil › with sinus
- Parulis › with sinus
K05.2
Aggressive periodontitis
Not billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Use when the record says
- Acute pericoronitis
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027