K04.7Periapical abscess without sinus

K04.7 is the ICD-10-CM diagnosis code for periapical abscess without sinus. It belongs to category K04 (diseases of pulp and periapical tissues), block K00-K14 (diseases of oral cavity and salivary glands) and chapter 11 (diseases of the digestive system). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within K04, choose K04.7 (Periapical abscess without sinus) only when documentation doesn't support a more specific option: pulpitis (K04.0), necrosis of pulp (K04.1), pulp degeneration (K04.2), abnormal hard tissue formation in pulp (K04.3), acute apical periodontitis of pulpal origin (K04.4), chronic apical periodontitis (K04.5), periapical abscess with sinus (K04.6), Radicular cyst (K04.8) and 1 more.

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 011 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC, relative weight 5.6154), DRG 012 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC, relative weight 4.381), DRG 013 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC, relative weight 2.7307), DRG 157 (Dental and Oral Diseases with MCC, relative weight 1.809), DRG 158 (Dental and Oral Diseases with CC, relative weight 0.9366) and DRG 159 (Dental and Oral Diseases without CC/MCC, relative weight 0.6893), in Pre-MDC and MDC 03 (Diseases and Disorders of the Ear, Nose, Mouth and Throat), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.

Before ICD-10, this condition was coded in ICD-9-CM as 522.5 (periapical abscess without sinus).