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ICD-10 Coding for Abdominal Wall Hernia(K43.2)

Complete ICD-10-CM coding and documentation guide for Abdominal Wall Hernia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Ventral HerniaIncisional HerniaUmbilical Hernia

Related ICD-10 Code Ranges

Complete code families applicable to Abdominal Wall Hernia

K43-K46Primary Range

Hernia of abdominal cavity

This range includes various types of abdominal wall hernias, including ventral, incisional, and umbilical hernias.

Key Information: ICD-10 code for abdominal wall hernia

Essential facts and insights about Abdominal Wall Hernia

The ICD-10 code for an abdominal wall hernia without obstruction or gangrene is K43.2. It is used when the hernia is incisional and reducible.

Primary ICD-10-CM Code for abdomen wall hernia

Incisional hernia without obstruction or gangrene
Billable Code

Decision Criteria

clinical Criteria

  • No signs of obstruction or gangrene

Applicable To

  • Incisional hernia without obstruction

Excludes

  • K43.0 (Incisional hernia with obstruction)
  • K43.1 (Incisional hernia with gangrene)

Clinical Validation Requirements

  • CT scan showing defect size
  • Physical exam noting reducibility

Code-Specific Risks

  • Misclassification if obstruction is present but not documented

Coding Notes

  • Ensure documentation specifies the absence of obstruction or gangrene.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Removal of infected mesh

11008
Use when infected mesh removal is necessary during hernia repair.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Incisional hernia with obstruction

K43.0
Presence of symptoms like nausea, vomiting, and non-reducible mass.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Abdominal Wall Hernia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K43.2.

Impact

Clinical: Inaccurate representation of surgical procedure, Regulatory: Non-compliance with coding guidelines, Financial: Potential loss of reimbursement for mesh use

Mitigation Strategy

Include mesh details in operative notes, Use templates to ensure completeness

Impact

Reimbursement: Potential underpayment for more complex cases, Compliance: Risk of audit failure, Data Quality: Inaccurate clinical data representation

Mitigation Strategy

Verify clinical documentation for signs of obstruction.

Impact

Failure to document precise defect size can lead to coding errors.

Mitigation Strategy

Use standardized templates to ensure all necessary details are captured.

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 Abdominal Wall Hernia, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Abdominal Wall Hernia

Use these documentation templates to ensure complete and accurate documentation for Abdominal Wall Hernia. These templates include all required elements for proper coding and billing.

Initial repair of ventral hernia

Specialty: General Surgery

Required Elements

  • Defect size
  • Location
  • Reducibility
  • Mesh use

Examples: Poor vs. Good Documentation

Poor Documentation Example
Repaired large hernia.
Good Documentation Example
Repaired 5 cm reducible ventral hernia with polypropylene mesh.
Explanation
The good example specifies the size, reducibility, and mesh use, which are critical for accurate coding.

Need help with ICD-10 coding for Abdominal Wall Hernia? Ask your questions below.

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