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K05.11

Billable

Chronic gingivitis, non-plaque induced

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

This is a long-term inflammation of the gums that is not caused by plaque buildup on the teeth. It may result from other factors such as hormonal changes, medications, or systemic diseases.

Coding Tips

  • Verify the documentation specifies 'non-plaque induced' to distinguish from the more common plaque-induced gingivitis (K05.10)
  • Look for documentation of the underlying cause (medication-induced, hormonal, systemic disease) as this may support medical necessity and help identify the root condition

Code Hierarchy

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