K04.5 vs K05.3
K04.5 (Chronic apical periodontitis) compared with K05.3 (Chronic periodontitis), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. K04.5 carries an Excludes1 note covering K05.3: “chronic periodontitis (K05.3-)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
No — do not report together. K05.3 carries an Excludes1 note covering K04.5: “chronic apical periodontitis (K04.5)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| K04.5Chronic apical periodontitis | K05.3Chronic periodontitis | |
|---|---|---|
| Billing status | Billable | Non-billable header |
| Classification | K00-K95 — Diseases of the Digestive System (K00-K95) | K00-K95 — Diseases of the Digestive System (K00-K95) |
| Definition | Chronic apical periodontitis is a billable ICD-10-CM diagnosis code (K04.5). | Chronic periodontitis is a non-billable ICD-10-CM category code (K05.3). |
| Includes | Apical or periapical granuloma Apical periodontitis NOS | Chronic pericoronitis Complex periodontitis Periodontitis NOS Simplex periodontitis |
| Use additional code | — | code to identify: alcohol abuse and dependence (F10.-) exposure to environmental tobacco smoke (Z77.22) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources