ICD-10 K12.2
Billable / Specific CCCellulitis and abscess of mouth
About ICD-10-CM K12.2
ICD-10-CM code K12.2 represents Cellulitis and abscess of mouth. This is a billable/specific code in the Digestive System chapter (block K12). The 2026 edition of ICD-10-CM K12.2 became effective on October 1, 2025.
Coding Tips for K12.2
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K12.2 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under K12.2. Per CMS ICD-10-CM Tabular 2026.
- Cellulitis of mouth (floor)
- Submandibular abscess
Type 2 Excludes
Not included here, the excluded code is not part of K12.2, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- abscess of salivary gland (K11.3)
- abscess of tongue (K14.0)
- periapical abscess (K04.6-K04.7)
- periodontal abscess (K05.21)
- peritonsillar abscess (J36)
Inpatient DRG Impact, CC
codes Cellulitis and abscess of mouth. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for K12.2
Local Coverage Determinations (LCDs) from CMS MACs that list K12.2 as a covered diagnosis.
Showing top 10 of 272 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K12.2.
1 Cigna
5 Medicare
1 Aetna
CPT Codes Commonly Billed with K12.2
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 10081 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
- 10180 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
- 10080 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
- 10160 CMS LCD: Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures CMS LCD
Convert K12.2 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 |
|---|---|---|
| K12.2 | 52800 | 10000 |
| K12.2 | 5283 | 10000 |
| K12.2 | 6820 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K12.2
Other codes in section K00-K14 (Diseases of oral cavity and salivary glands).
ICD-10 K12.2, Billing FAQ
Is ICD-10 code K12.2 billable? +
Yes, K12.2 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 K12.2? +
ICD-10 K12.2 includes: Cellulitis of mouth (floor); Submandibular abscess.
What codes are Type 2 Excludes for K12.2? +
Type 2 Excludes (may be coded together when both conditions exist): abscess of salivary gland (K11.3); abscess of tongue (K14.0); periapical abscess (K04.6-K04.7)
Is K12.2 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with K12.2? +
Procedures frequently paired with K12.2 include: 10081, 10180, 10080, 10160.
What ICD-9 codes does K12.2 map to? +
Per CMS GEMs, K12.2 maps to ICD-9 codes: 52800, 5283, 6820. 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 June 1, 2026.
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