ICD-10 Coding for Hernia(K40.90, K43.2)
Complete ICD-10-CM coding and documentation guide for Hernia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hernia
K40-K46Primary Range
Hernia codes covering various types such as inguinal, femoral, umbilical, and incisional hernias
This range includes the primary ICD-10 codes for different types of hernias.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K40.90 | Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent | Use when diagnosing a unilateral inguinal hernia without complications or prior repairs. |
|
| K43.2 | Incisional hernia without obstruction or gangrene | Use for incisional hernias identified post-surgery without complications. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: How is a hernia coded in ICD-10?
Essential facts and insights about Hernia
Primary ICD-10-CM Codes for hernia
Decision Criteria
clinical Criteria
- Presence of a unilateral inguinal bulge without previous surgical history
Applicable To
- Unilateral inguinal hernia without obstruction or gangrene
Clinical Validation Requirements
- Physical examination confirming inguinal bulge
- Patient history indicating no prior hernia repair
Code-Specific Risks
- Misclassification if bilateral or recurrent
Coding Notes
- Ensure laterality is documented to avoid misclassification.
K43.2 - Incisional hernia without obstruction or gangrene
Use for incisional hernias identified post-surgery without complications.
Applicable To
- Incisional hernia without obstruction or gangrene
Excludes
- Ventral hernia (K43.9)
Clinical Validation Requirements
- Operative report confirming incisional hernia
- No signs of obstruction or gangrene
Coding Notes
Ensure surgical history is documented to confirm incisional nature.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Bilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent
K40.20Incisional hernia with obstruction, without gangrene
K43.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hernia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K40.90.
Impact
Clinical: Inadequate clinical records, Regulatory: Non-compliance with coding standards, Financial: Potential for denied claims
Mitigation Strategy
Use standardized templates, Review documentation before submission
Impact
Reimbursement: May lead to incorrect payment or denial, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate patient records
Mitigation Strategy
Verify laterality through physical examination and documentation.
Impact
Failure to document mesh use can lead to audit issues.
Mitigation Strategy
Ensure all operative reports include detailed mesh information.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hernia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hernia
Use these documentation templates to ensure complete and accurate documentation for Hernia. These templates include all required elements for proper coding and billing.
Open repair of incisional hernia
Specialty: General SurgeryRequired Elements
- Hernia location and size
- Mesh type and placement
- Intraoperative findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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