Official Disability Guidelines
DISEASES OF PULP AND PERIAPICAL TISSUES
(3-digit ICD9 522)

522  Diseases of pulp and periapical tissues

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

ICD-10 Code: K04
ODG Treatment UR Advisor: 522
Hospital Costs: $9,398 (average of 7,006 cases)
Hospital Length Of Stay: 3.0 days
CM Triage: Level 1 (low touch), inflection point 10 days

Workers' Comp Costs per Claim (based on 48 claims)
Quartile25%50%75%Mean% no cost
Medical$1,021$3,136$6,509$7,6689%
Total$1,021$4,207$10,728$10,5399%

522.0  Pulpitis

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

Description: Inflammation of the pulp of a tooth.
              Pulpal:
                abscess
                polyp
              Pulpitis:
                acute
                chronic (hyperplastic) (ulcerative)
                suppurative
ICD-10 Code: K04.0
ODG Treatment UR Advisor: 522.0
Hospital Costs: $5,715
Hospital Length Of Stay: 3.2 days
CM Triage: Level 1 (low touch), inflection point 10 days
Impact on Total Absence: Prevalence 0.0001% of total lost workdays

522.1  Necrosis of the pulp

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

Description: Death of pulp tissue in a tooth.
              Pulp gangrene
ICD-10 Code: K04.1
ODG Treatment UR Advisor: 522.1
Causality Likelihood: Zero
CM Triage: Level 1 (low touch), inflection point 10 days

522.2  Pulp degeneration

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

              Denticles
              Pulp calcifications
              Pulp stones
ICD-10 Code: K04.2
Causality Likelihood: Zero
Hospital Costs: $11,169
Hospital Length Of Stay: 3.0 days
CM Triage: Level 1 (low touch), inflection point 10 days

522.3  Abnormal hard tissue formation in pulp

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

              Secondary or irregular dentin
ICD-10 Code: K04.3
CM Triage: Level 1 (low touch), inflection point 10 days

522.4  Acute apical periodontitis of pulpal origin

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days16 days
All absences2 days5 days

Description: Severe inflammation of a periodontal ligament due to inflammation or death of the pulp of a tooth.
ICD-10 Code: K04.4
Causality Likelihood: Zero
Hospital Costs: $10,960 (average of 580 cases)
Hospital Length Of Stay: 3.0 days
CM Triage: Level 1 (low touch), inflection point 13 days

RTW Claims Data (Calendar-days away from work by decile)

10%20%30%40%50%60%70%80%90%100%Mean
1010111111131415161612.50

   Integrated Disability Durations, in days*
   Median (mid-point)     2.0        Mean (average)        3.26
   Mode (most frequent)   2          Calculated rec.       2
                           Percent of Cases
                              (118 cases)
                                                                      
      29.7                                                            
                                                                      
                                                                      
                                                                      
 17.8                                                                 
           14.4                                                       
                                                                      
                 8.5                                                  
                      5.9                                             
                           0.8  0.0  0.0  0.0  1.7  1.7  0.0  0.8  2.5
  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___
    1    2    3    4    5    6    7    8    9   10   11   12   13  14+
                               Days
   *CDC NHIS cases with no lost workdays: 19 (16.1%)

Impact on Total Absence: Prevalence 0.0006% of total lost workdays; Incidence 0.01 days per 100 workers

522.5  Periapical abscess without sinus

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data14 days21 days
All absences2 days6 days

Return-To-Work "Best Practice" Guidelines
Regular dental hygiene: 0 days
Root canal therapy: 1 day
Tooth extraction, forceps: 1 day
Tooth extraction, surgical, clerical/modified work: 2 days
Tooth extraction, surgical, manual/regular work: 4 days

RTW Prescription: 522.5 New!
Description: A collection of pus that has spread from a tooth to the surrounding tissues, usually as a result of an infection.  Toothache, pain upon swallowing or eating, reddening of the gums, and/or sensitivity to heat or cold are among the symptoms.
              Abscess:
                dental
                dentoalveolar
              Excludes:
              periapical abscess with sinus (522.7)

ICD-10 Code: K04.7
Other Links: Click below for detailed information on this condition:
Merck Manual | Merck Home Edition | NGC
Causality Likelihood: Zero
Hospital Costs: $9,162 (average of 6,259 cases)
Hospital Length Of Stay: 3.0 days
CM Triage: Level 1 (low touch), inflection point 14 days

RTW Claims Data (Calendar-days away from work by decile)

10%20%30%40%50%60%70%80%90%100%Mean
913131414151720213615.91

   Integrated Disability Durations, in days*
   Median (mid-point)     2.0        Mean (average)        3.17
   Mode (most frequent)   2          Calculated rec.       2
                           Percent of Cases
                              (490 cases)
                                                                      
      31.6                                                            
 27.3                                                                 
                                                                      
                                                                      
                                                                      
                                                                      
                12.0                                                  
            6.7                                                       
                      4.3  3.9                                        
                                3.1  0.2  0.4  0.0  0.0  0.2  0.6  3.1
  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___
    1    2    3    4    5    6    7    8    9   10   11   12   13  14+
                               Days
   *CDC NHIS cases with no lost workdays: 32 (6.5%)

Impact on Total Absence: Prevalence 0.0029% of total lost workdays; Incidence 0.03 days per 100 workers

522.6  Chronic apical periodontitis

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

Description: Persistent inflammation of a periodontal ligament due to inflammation or death of the pulp of a tooth.
              Apical or periapical granuloma
              Apical periodontitis NOS
ICD-10 Code: K04.5
Hospital Costs: $4,853
Hospital Length Of Stay: 2.0 days
CM Triage: Level 1 (low touch), inflection point 14 days

522.7  Periapical abscess with sinus

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

              Fistula:
                alveolar process
                dental
ICD-10 Code: K04.6
Hospital Costs: $12,833 (average of 167 cases)
Hospital Length Of Stay: 3.0 days
CM Triage: Level 1 (low touch), inflection point 14 days

522.8  Radicular cyst

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

              Cyst:
                apical (periodontal)
                periapical
                radiculodental
                residual radicular
              Excludes:
              lateral developmental or lateral periodontal cyst (526.0)

ICD-10 Code: K04.8
CM Triage: Level 1 (low touch), inflection point 14 days

522.9  Other and unspecified diseases of pulp and periapical tissues

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data11 days19 days
All absences2 days8 days

ICD-10 Code: K04.9
Hospital Costs: $11,638
CM Triage: Level 1 (low touch), inflection point 14 days

ODG 2011 Work Loss Data Institute. All Rights Reserved.

CPT 2011 American Medical Association. All Rights Reserved.

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