K04.7 vs K05.2
K04.7 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 (K04.7)
K04.7
Periapical abscess without sinus
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Use when the record says
- Dental abscess without sinus
- Dentoalveolar abscess without sinus
Indexed under
- Gumboil
- Parulis
- Abscess › alveolar (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic)
- Abscess › apical (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic)
- Abscess › dental (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic)
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