ICD-10 Coding for Incisional Hernia(K43.0, K43.2)
Complete ICD-10-CM coding and documentation guide for Incisional Hernia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Incisional Hernia
K43.0-K43.9Primary Range
Hernia of anterior abdominal wall
This range includes all types of incisional hernias, with or without obstruction or gangrene.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K43.0 | Incisional hernia with obstruction, without gangrene | Use when an incisional hernia presents with obstruction but no signs of gangrene. |
|
| K43.2 | Incisional hernia with gangrene | Use when gangrene is present in the incisional hernia. |
|
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: ICD-10 code for incisional hernia
Essential facts and insights about Incisional Hernia
Primary ICD-10-CM Codes for incisional hernia
Decision Criteria
clinical Criteria
- Obstruction without gangrene confirmed by imaging
Applicable To
- Incarcerated incisional hernia
Excludes
- Incisional hernia with gangrene (K43.2)
Clinical Validation Requirements
- CT scan showing obstruction
- Symptoms of vomiting and constipation
Code-Specific Risks
- Incorrectly coding as gangrenous when no gangrene is present
Coding Notes
- Ensure documentation specifies the absence of gangrene.
K43.2 - Incisional hernia with gangrene
Use when gangrene is present in the incisional hernia.
Applicable To
- Gangrenous incisional hernia
Excludes
- Incisional hernia without gangrene (K43.0)
Clinical Validation Requirements
- Necrotic tissue observed during surgery
- Elevated lactate levels
Coding Notes
Document gangrene clearly in the operative report.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Right upper quadrant pain
R10.11Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Incisional Hernia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K43.0.
Impact
Clinical: Inadequate documentation of surgical procedure., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Include mesh type and size in operative notes., Document placement technique.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify if the hernia is at the same site as a previous repair to determine if it is recurrent.
Impact
Inaccurate or missing defect size can lead to incorrect coding.
Mitigation Strategy
Ensure precise measurement and documentation of defect size.
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 Incisional Hernia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Incisional Hernia
Use these documentation templates to ensure complete and accurate documentation for Incisional Hernia. These templates include all required elements for proper coding and billing.
Repair of incarcerated incisional hernia
Specialty: General SurgeryRequired Elements
- Defect size
- Incarceration status
- Mesh type and placement
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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