Is K08.5 a billable ICD-10-CM code?

No. K08.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does K08.5 sit in the tabular list?

Diseases of the digestive system (K00-K95), in the block Diseases of oral cavity and salivary glands (K00-K14).

What cannot be coded together with K08.5?

K08.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

K08.5

K08.5 — Unsatisfactory restoration of tooth

Non-billable headerICD-10-CM

K08.5 is a non-billable header ICD-10-CM code for unsatisfactory restoration of tooth. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

dental restoration status (Z98.811)

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

endosseous dental implant failure (M27.6-)
unsatisfactory endodontic treatment (M27.5-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Defective bridge, crown, filling
Defective dental restoration

Risk adjustment

K08.5 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead K08.5

8 child codes. Green means billable.

Related codes at this level

Codes that share K08. If K08.5 is not quite right, the correct code is usually one of these.

Questions about K08.5

Is K08.5 a billable ICD-10-CM code?: No. K08.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does K08.5 sit in the tabular list?: Diseases of the digestive system (K00-K95), in the block Diseases of oral cavity and salivary glands (K00-K14).
What cannot be coded together with K08.5?: K08.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.