Done wracking my brain for Loss of Domain


Staten Island, NY
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When ICD coding for hernia doesn't quite capture the significance of LOSS OF DOMAIN
and Loss of Domain does not have a specific or unspecified or for that matter a NEC ICD-10-CM code.
So, what’s a coder to do?
Short answer: (which I know many prefer), follow the guidelines for what you understand about the condition. This will lead you right back to HERNIA. So, what is herniated? The gastrointestinal tract –
Note: see Hernia, abdomen – Hernia, abdomen K46.9 (Tabular lists Intestinal Hernia)
I’m using this code (K46.9) as well as incisional hernia and any other documented hernias which co-exist… in order to give the full picture of the patient’s condition (s) and severity of loss of domain for medical necessity of abdominal reconstruction with hernia repair.
– KEEP reading because there is another code I use as well.
I do not code Injury, abdominal or intestinal because this is not what occurred.
I do not code Open wound either and you can beg to differ here, but the protrusion is an internal evisceration of the Intestines and not Abdominal Wall Evisceration. An Abdominal Wall evisceration occurs with an open wound, if I understand that correctly. So, I tried Evisceration, intestines and got a red light because only subterms listed under the main term are:
Birth injury
Traumatic NEC
It is not ALWAYS traumatic when an intestinal evisceration occurs, as providers sometimes call it, but a loss of domain. We cannot code that anyway because ICD-10-CM doesn’t even give a potential code. Why? Because Trauma, NEC is coded to actual injury(s).
Loss of domain exists when the ratio of the volume of the hernia sac to the volume of the abdominal cavity is ≥0.5
I tried many different possible conditions to code Loss of Domain… from Weak Muscle to Protrusion to Post Op complications and bottom line….
I code for NON Traumatic, Loss of Domain (Abdominal):
K46.9, Intestinal Hernia WITH K91.89 Other Postprocedural Complications and disorders of digestive system. (when provider documents recurrent hernia, previous major abdominal surgeries and correlation).

Would love some feedback…


True Blue
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I think you've correctly stated that 'loss of domain', without any additional information, does not translate to a specific code. I believe that the term as you've described it is one that refers to the severity of the hernia itself and not to a separate or unrelated condition. Since ICD-10 does not have that level of specificity in the hernia codes, I would leave it at that and not try to find an additional diagnosis code since it not really a separate condition unrelated to the hernia.

Keep in mind that ICD codes can never capture the full clinical picture of every patient, nor are they designed to, and it is understood that sometimes there is no substitute for just having to review the records to get a true and complete understanding of the patient's condition and medical needs. I don't know if any of your payers have coverage limitations on this type of procedure, but if they do, they should have a written policy which you can refer to that would give you additional guidance on which codes, if any, they expect or recognize in order to meet their payment eligibility requirements. (Medicare LCDs, for example, will frequent designate certain unspecified ICD-10 codes to represent conditions that meet the medical necessity criteria for tests or procedures but which do not have their own specific assigned code.) Other payers that have coverage limitations, instead of publishing a policy may require authorization for the procedure in which case they will typically want to review records prior to authorizing it. The review would take this information in the record into account and thereby make it unnecessary to have additional codes on the claim in order to get payment.