K04.0 ICD-10-CM Code: Pulpitis

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K04.0 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Coder workflow for K04.0

MedCoder structured workflow — derived from this code’s own official record

Before you code K04.0

1. K04.0 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

   ReviewK04.01, K04.02

   See the relationships section · Guide: How to choose an ICD-10-CM code →

Choose the right path

1. Does the documentation support one of the more specific codes beneath K04.0?
   Yes → Select that code and continue the checks below on its own page.
   No → K04.0 cannot be reported as written; query for the specificity its subcategory needs.

   ReviewK04.01, K04.02

Consider K04.0. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Acuity

Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).

The associated condition or complication

Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse K04.0 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of K04.0 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• K04.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Other and unspecified diseases of pulp and periapical tissues” takes K04.9; specificity in the record moves it back here.

  Full comparison: K04.0 vs K04.9 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• Not billable as written — a more specific code is required: K04.01, K04.02.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Clinical classification (AHRQ CCSR):DIG002 — Disorders of teeth and gingiva (default); DEN001 — Any dental condition including traumatic injury; DEN002 — Nontraumatic dental conditions; DEN003 — Caries, periodontitis, and other preventable dental conditions.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Disorders of teeth and gingiva, Any dental condition including traumatic injury, Nontraumatic dental conditions, Caries, periodontitis, and other preventable dental conditions).

K03.1 — Abrasion of teeth, K03.2 — Erosion of teeth, K03.3 — Pathological resorption of teeth, K03.4 — Hypercementosis, K03.5 — Ankylosis of teeth, K03.6 — Deposits [accretions] on teeth, K03.7 — Posteruptive color changes of dental hard tissues, K03.81 — Cracked tooth, K03.89 — Other specified diseases of hard tissues of teeth, K03.9 — Disease of hard tissues of teeth, unspecified, K04.01 — Reversible pulpitis, K04.02 — Irreversible pulpitis, K04.1 — Necrosis of pulp, K04.2 — Pulp degeneration, K04.3 — Abnormal hard tissue formation in pulp, K04.4 — Acute apical periodontitis of pulpal origin, K04.5 — Chronic apical periodontitis, K04.6 — Periapical abscess with sinus, K04.7 — Periapical abscess without sinus, K04.8 — Radicular cyst, +613 more

Contextual Map

Every relationship of K04.0 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

• K00-K95 — Chapter 11: Diseases of the Digestive System (K00-K95) (K00-K95)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K00-K14 — Diseases of oral cavity and salivary glands[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Clinical classification (CCSR)

• DIG002 — Disorders of teeth and gingiva[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• DEN001 — Any dental condition including traumatic injury[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• DEN002 — Nontraumatic dental conditions[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• DEN003 — Caries, periodontitis, and other preventable dental conditions[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Nearest codes (14)

• K04 — Diseases of pulp and periapical tissues[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.01 — Reversible pulpitis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.02 — Irreversible pulpitis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.1 — Necrosis of pulp[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.2 — Pulp degeneration[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.3 — Abnormal hard tissue formation in pulp[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.4 — Acute apical periodontitis of pulpal origin[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K04.5 — Chronic apical periodontitis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 6 more

Change history (2)

• FY2017 — Became a non-billable header[Change history]— CMS release files (code change ledger) · icd10cm-fy2017
• and 1 more

Common coding questions

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K04.0 in its code family, with their registry titles.

• K04 — Diseases of pulp and periapical tissues
• K04.01 — Reversible pulpitis
• K04.02 — Irreversible pulpitis
• K04.1 — Necrosis of pulp
• K04.2 — Pulp degeneration
• K04.3 — Abnormal hard tissue formation in pulp
• K04.4 — Acute apical periodontitis of pulpal origin
• K04.5 — Chronic apical periodontitis
• K04.6 — Periapical abscess with sinus
• K04.7 — Periapical abscess without sinus

View all codes in the K04 family