ICD-10 Supports All Types of Hernias

ICD-10 Supports All Types of Hernias

Proper documentation should reveal the type, location, and complications for precise diagnosis coding.

By Rhonda Buckholtz

Hernias occur when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias may not produce symptoms, or they may cause slight to severe pain. Nearly all have the potential of becoming strangulated.

Strangulation occurs when the contents of the hernia bulge out and apply enough pressure that blood vessels in the hernia are constricted, cutting off blood supply. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency.

Identify Hernia Type

There are several different types of hernias. The ability to identify the various types of hernias is critical to appropriate diagnosis coding in ICD-10-CM.

Inguinal

Inguinal (groin) hernias make up approximately 75 percent of all abdominal wall hernias, and occur up to 25 times more often in men than in women. There are two different types of inguinal hernias: direct and indirect.

Both types occur in the groin area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly different origins.

  • Indirect inguinal hernia (indirect hernia):
    • Follows the pathway that the testicles made during fetal development, descending from the abdomen into the scrotum; and
    • May occur at any age.
  • Direct inguinal hernia:
    • Occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner;
    • Rarely protrudes into the scrotum; and
    • Tends to occur in the middle-aged and elderly because abdominal walls weaken with age.

ICD-10-CM coding example:

James has been diagnosed with a unilateral inguinal hernia with obstruction and gangrene that has been recurrent.

K40.41 Unilateral inguinal hernia, with gangrene, recurrent

Femoral

Femoral hernias are normally confined to a tight space, and sometimes they become large enough to allow abdominal contents (usually intestine) to protrude into the canal. They cause a bulge just below the inguinal crease in roughly the mid-thigh area, and usually occur in women.

ICD-10-CM coding example:

A 78-year-old woman presented with a two day history of a painful mass in her right groin. Abdominal examination disclosed mild tenderness in the right lower quadrant. A 6 cm right inguinal mass was palpated that was non-reducible and exquisitely tender to palpation. At laparotomy, a large, edematous, inflamed femoral mass, medial to the femoral vein, was identified. The anterior surface was opened, and purulent fluid was drained. The femoral hernia was repaired by suturing the iliopubic tract to Cooper’s ligament.

K41.90 Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent

Umbilical

Umbilical hernias are common and make up approximately 10 to 30 percent of hernia cases. They are often noted at birth as a protrusion at the belly.

ICD-10-CM coding example:

A 42-year-old female patient presents with a gangrenous Meckel’s diverticulum in a strangulated umbilical hernia sac. She was treated by dissection of diverticulomesenteric bands and diverticulectomy.

K42.0 Umbilical hernia with obstruction, without gangrene

Q43.0 Meckel’s diverticulum

Incisional

  • An incisional hernia can occur:
  • When abdominal surgery causes a flaw in the abdominal wall, creating an area of weakness through which a hernia may develop
  • Following 2-10 percent of all abdominal surgeries

ICD-10-CM coding example:

Tim noticed a bulge in his abdominal wall following abdominal surgery this past year. He indicates the bulge appears to expand under increased abdominal pressure, such as when he coughs or lifts a heavy object. The physician diagnoses him with an incisional hernia.

K43.2 Incisional hernia without obstruction, without gangrene

Spigelian 

Spigelian hernias are rare and occur along the edge of the rectus abdominus muscle through the spigelian fascia. In ICD-10-CM, spiglian hernias are coded to K43.6 Other and unspecified ventral hernia with obstruction, without gangrene or K43.7 Other and unspecified ventral hernia with gangrene, depending on whether gangrene is present.

Obturator

Obturator hernia is an extremely rare abdominal hernia, which develops mostly in women. This type of hernia protrudes from the pelvic cavity through an opening in the pelvic bone. Due to the lack of visible bulging, this hernia is very difficult to diagnose.

Epigastric

Epigastric hernia occurs between the navel and the lower part of the rib cage in the midline of the abdomen. It’s composed usually of fatty tissue and rarely contains intestine. In ICD-10-CM, epigastric hernias are coded to K43.6, K43.7, or K43.9 Ventral hernia without obstruction or gangrene, depending on the presence of obstruction or gangrene.

Diaphragmatic 

A diaphragmatic hernia is a rare birth defect in which there is an abnormal opening in the diaphragm. This type of hernia occurs while the baby is developing in the womb, and prevents the lungs from growing normally.

ICD-10-CM coding example:

A 17-year-old female presents with congenital diaphragmatic hernia. She originally presented with vague abdominal pain and was thought to have urinary tract infection, ruptured ovarian cyst, and appendicitis by different medical teams in the first few days. Recently, she underwent a diagnostic laparoscopy with no significant findings. In the early postoperative recovery period, she suffered from severe cardiorespiratory distress and a large intestinal left diaphragmatic hernia was diagnosed subsequently. Today, during surgery, a strangulated loop of large bowel herniating through a left antero-lateral congenital diaphragmatic hernia was discovered, which was reduced and repaired with a Prolene mesh through thoracotomy.

K44.0 Diaphragmatic hernia with obstruction without gangrene

Proper Documentation Allows Seamless Coding

Educating physicians on documenting hernias is fairly simple. Work with them on concepts such as:

  • Type
  • Laterality
  • Location
  • Complications/Manifestations

Combining your knowledge of the clinical condition with the physician’s documentation allows for seamless selection of the most specific ICD-10-CM code.


 

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.

Rhonda Buckholtz

Rhonda Buckholtz

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC,has more than 20 years of experience in healthcare, working in the reimbursement, billing, and coding sectors, in addition to being an instructor. She is responsible for all ICD-10 training and curriculum at AAPC. She has authored many articles for health care publications and has spoken at conferences across the country. She is co-chair for the WEDI ICD-10 Implementation Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. She also sits on the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark Medicare Services).
Rhonda Buckholtz

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Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, has more than 20 years of experience in healthcare, working in the reimbursement, billing, and coding sectors, in addition to being an instructor. She is responsible for all ICD-10 training and curriculum at AAPC. She has authored many articles for health care publications and has spoken at conferences across the country. She is co-chair for the WEDI ICD-10 Implementation Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. She also sits on the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark Medicare Services).

2 Responses to “ICD-10 Supports All Types of Hernias”

  1. Kendra says:

    Does this hold true for “Newborn” Umbilical Granuloma

  2. Mike says:

    I’ve found it lacking. What about the case of a patient with bilateral inguinal hernias where one is recurrent and the other has never been repaired? Does K40.21 (Bilateral inguinal hernia, without obstruction or gangrene, recurrent) apply if just one is recurrent or must they both be recurrent?

    Should this common situation be classified by K40.20 (Bilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent) since the patient has bilateral hernias but they are not both recurrent and K40.91 (Unilateral inguinal hernia, without obstruction or gangrene, recurrent)?

    Or should it be classified by K40.90 (Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent) and K40.91 (Unilateral inguinal hernia, without obstruction or gangrene, recurrent) which misses the opportunity to classify the patient with bilateral hernias? I’ve found little guidance on how to code this situation.

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