Is K12.1 a billable ICD-10-CM code?

Yes. K12.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does K12.1 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 K12.1?

K12.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

K12.1

K12.1 — Other forms of stomatitis

Billable / specific codeICD-10-CM

K12.1 is a billable, specific ICD-10-CM code for other forms of stomatitis. It is valid for submission on a claim.

Excludes1 — never code together

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

acute necrotizing ulcerative stomatitis (A69.1)
Vincent's stomatitis (A69.1)

Inclusion terms

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

Stomatitis NOS
Denture stomatitis
Ulcerative stomatitis
Vesicular stomatitis

Risk adjustment

K12.1 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.

Medicare coverage

K12.1 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

How K12.1 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to K12.1.

Stomatitis(denture) (ulcerative)
Catarrh, catarrhal›mouth
Inflammation, inflamed, inflammatory›mouth
Stomatitis›catarrhal
Stomatitis›follicular
Stomatitis›malignant
Stomatitis›membranous acute
Stomatitis›septic
Stomatitis›vesicular
Ulcer, ulcerated, ulcerating, ulceration, ulcerative›buccal(cavity) (traumatic)
Ulcer, ulcerated, ulcerating, ulceration, ulcerative›oral mucosa(traumatic)
Ulcer, ulcerated, ulcerating, ulceration, ulcerative›palate(soft)

Related codes at this level

Codes that share K12. If K12.1 is not quite right, the correct code is usually one of these.

Questions about K12.1

Is K12.1 a billable ICD-10-CM code?: Yes. K12.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does K12.1 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 K12.1?: K12.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.