Gastroenterology Coding Alert

Hint: Presence or absence of gangrene is still the deciding factor to arrive at the right code.

When your gastroenterologist diagnoses umbilical hernia, you’ll continue to use the presence or absence of obstruction or gangrene as the basis for reporting the condition with ICD-10 codes.

ICD-9: While reporting a diagnosis of umbilical hernia, you have three code choices to choose from depending on if your gastroenterologist identifies the presence or absence of any obstruction or gangrene. So, you will have to report the condition using one of the following three code choices:

• 551.1 (Umbilical hernia with gangrene)
• 552.1 (Umbilical hernia with obstruction)
• 553.1 (Umbilical hernia without obstruction or gangrene)

Note More Specificity to Umbilical Hernia With Obstruction
in ICD-10

When you begin using ICD-10 codes after Oct.1, 2014, you’ll have to report a diagnosis of umbilical hernia with K42 (Umbilical hernia). Again, depending on the presence or absence of obstruction or gangrene, you have three code choices to more accurately report the condition. You can report a diagnosis of umbilical hernia with these three codes in ICD-10:

• K42.0 (Umbilical hernia with obstruction, without gangrene)
• K42.1 (Umbilical hernia with gangrene)
• K42.9 (Umbilical hernia without obstruction or gangrene)

If you look at the descriptor to K42.0, you’ll notice that this descriptor has been made more specific than its ICD-9 predecessor, namely 552.1 as it is specific for umbilical hernia with obstruction and specifically mentions that there is no gangrene.

Caveats: You’ll have to use K42.0 if your gastroenterologist makes a diagnosis of incarcerated umbilical hernia, irreducible umbilical hernia or strangulated umbilical hernia when no gangrene is mentioned in the documentation. Use K42.9 when the diagnosis is umbilical hernia NOS.

Focus on These Basics Briefly

Documentation spotlight: When your gastroenterologist diagnoses umbilical hernia, some of the signs and symptoms that you are more likely to see in patient documentation will include pain, tenderness in the area around the umbilicus, vomiting and redness of the affected area. In young infants, the umbilical hernia will be seen as a protrusion when the child cries or coughs. Sometimes, there might be no evident signs and symptoms and your gastroenterologist might notice the presence of the umbilical hernia during a physical examination.

An umbilical hernia will be identified by your gastroenterologist during a physical examination. Your gastroenterologist will decide if any surgical repair is necessary based on the fascial defect rather than the amount of protrusion. Also, repair is not indicated in very young children below the age of five as in most cases, the condition will resolve on its own without any intervention.

When your gastroenterologist diagnoses an umbilical hernia, he might ask for imaging studies such as an x-ray or an ultrasound to see if there are any complicating factors such as strangulation, obstructions or the presence of gangrene.

Example: Your gastroenterologist reviews a 53-year-old female patient of African American origin for complaints of severe pain that has developed around her umbilical area over the past few weeks. The patient told that she had a bulge over her umbilical area right since childhood and it had never troubled her in the past although the size of the protrusion had increased significantly following the birth of her third child about 15 years ago.

Upon examination, your gastroenterologist notes significant protrusion of tissue in the umbilical area and observes signs of strangulation of the protruded tissue and notices signs of gangrene. He makes a diagnosis of umbilical hernia and orders for an abdominal ultrasound and x-ray.

Based on the observations during physical examination and from the results of the imaging studies, your gastroenterologist makes a diagnosis of umbilical hernia with gangrene. You’ll report this diagnosis with K42.1 if you’re using ICD-10 codes or report 551.1 with ICD-9 codes.