Urology Coding Alert

You'll still need obstruction, recurrence data as well.

If your urologist teams up with general surgeons to perform procedures involving inguinal hernias -- such as a combined hernia and orchiopexy surgery -- pay attention to the hernia coding changes coming on Oct. 1, 2013.

You'll have the same number of code choices and the same diagnostic distinctions for coding inguinal hernias when ICD-9 becomes ICD-10. But elevating the bilateral/unilateral distinction from the fifth digit in ICD-9 to the fourth digit in ICD-10 confounds the one-to-one code correspondence.

ICD-9 Prioritizes Gangrene, Obstruction

ICD-9 lists three, four-digit codes for inguinal hernia:

• 550.0 -- Inguinal hernia with gangrene
• 550.1 -- ... with obstruction, without mention of gangrene
• 550.9 -- ... without mention of obstruction or gangrene.

You should append a fifth digit to each of these codes to distinguish bilateral/unilateral and recurrent or not, as follows:

• 0 -- unilateral or unspecified (not specified as recurrent)
• 1 -- unilateral or unspecified, recurrent
• 2 -- bilateral (not specified as recurrent)
• 3 -- bilateral, recurrent.

ICD-10 Prioritizes Gangrene, Obstruction, and Unilateral/Bilateral

ICD-10 lists six, four digit codes for inguinal hernia:

• K40.0 -- Bilateral inguinal hernia, with obstruction, without gangrene
• K40.1 -- ... with gangrene
• K40.2 -- ... without obstruction or gangrene
• K40.3 -- Unilateral inguinal hernia, with obstruction, without gangrene
• K40.4 -- ... with gangrene
• K40.9 -- ... without obstruction or gangrene.

You should append a fifth digit to each of these codes to distinguish recurrent or not as follows:

• 0 -- not specified as recurrent
• 1 -- recurrent.

Put Them Together for 12 Codes

Because of the hierarchy difference, you can't find a direct correspondence for the four-digit codes. For instance, 550.0 could be K40.1 or K40.4.

Crosswalk: You do have a one-to-one crosswalk of the five-digit inguinal hernia codes from ICD-9 to ICD-10, as follows:

• 550.00 - K40.40
• 550.01 - K40.41
• 550.02 - K40.10
• 550.03 - K40.11
• 550.10 - K40.30
• 550.11 - K40.31
• 550.12 - K40.00
• 550.13 - K40.01
• 550.90 - K40.90
• 550.91 - K40.91
• 550.92 - K40.20
• 550.93 - K40.21