ICD-10 K04.3
Billable / SpecificAbnormal hard tissue formation in pulp
About ICD-10-CM K04.3
ICD-10-CM code K04.3 represents Abnormal hard tissue formation in pulp. This is a billable/specific code in the Digestive System chapter (block K04). The 2026 edition of ICD-10-CM K04.3 became effective on October 1, 2025.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under K04.3. Per CMS ICD-10-CM Tabular 2026.
- Secondary or irregular dentine
Medicare LCD Coverage for K04.3
Local Coverage Determinations (LCDs) from CMS MACs that list K04.3 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K04.3.
1 Cigna
CPT Codes Commonly Billed with K04.3
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert K04.3 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| K04.3 | 5223 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K04.3
Other codes in section K00-K14 (Diseases of oral cavity and salivary glands).
ICD-10 K04.3, Billing FAQ
Is ICD-10 code K04.3 billable? +
Yes, K04.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to K04.3? +
ICD-10 K04.3 includes: Secondary or irregular dentine.
What ICD-9 codes does K04.3 map to? +
Per CMS GEMs, K04.3 maps to ICD-9 codes: 5223. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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