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ICD-10 Coding for Epigastric Hernia(K43.6, K43.7, K43.9)

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

Also known as:

Ventral HerniaUpper Abdominal Hernia

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Related ICD-10 Code Ranges

Complete code families applicable to Epigastric Hernia

K43.6-K43.9Primary Range

Ventral hernia codes

These codes cover various types of ventral hernias, including epigastric hernias, with or without complications such as obstruction or gangrene.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
K43.6Other and unspecified ventral hernia with obstruction, without gangreneUse when an epigastric hernia presents with obstruction but no gangrene.
  • Non-reducible hernia with vomiting or constipation
  • Imaging showing bowel incarceration
K43.7Other and unspecified ventral hernia with gangreneUse when gangrene is present in the hernia.
  • Ischemic bowel or necrosis confirmed intraoperatively
  • Elevated lactate or WBC
K43.9Ventral hernia without obstruction or gangreneUse for uncomplicated, reducible epigastric hernias.
  • Reducible hernia without symptoms of obstruction or gangrene

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for epigastric hernia

Essential facts and insights about Epigastric Hernia

The ICD-10 code for an epigastric hernia without obstruction or gangrene is K43.9. Use K43.6 if obstruction is present and K43.7 if gangrene is confirmed.

Primary ICD-10-CM Codes for epigastric hernia

K43.6
Other and unspecified ventral hernia with obstruction, without gangrene
Billable Code

Decision Criteria

clinical Criteria

  • Presence of obstruction without gangrene

Applicable To

  • Epigastric hernia with obstruction

Excludes

  • Ventral hernia with gangrene (K43.7)

Clinical Validation Requirements

  • Non-reducible hernia with vomiting or constipation
  • Imaging showing bowel incarceration

Code-Specific Risks

  • Misclassification if gangrene is present

Coding Notes

  • Ensure documentation specifies obstruction without gangrene.
View Full Code Details

Ancillary Codes

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

Postprocedural adhesions

K91.89
Use when hernia is due to adhesions from prior surgery.

Differential Codes

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

Other and unspecified ventral hernia with gangrene

K43.7
Presence of gangrene or ischemic bowel confirmed intraoperatively.

Other and unspecified ventral hernia with obstruction, without gangrene

K43.6
Absence of gangrene.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Epigastric Hernia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K43.6.

Impact

Clinical: Impacts surgical planning and outcomes., Regulatory: Non-compliance with coding standards., Financial: Potential undercoding and revenue loss.

Mitigation Strategy

Measure and document defect size pre-operatively, Verify size intraoperatively

Impact

Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate clinical data recording.

Mitigation Strategy

Clarify location as epigastric (above umbilicus) or umbilical (at umbilicus).

Impact

Reimbursement: Potential underpayment if gangrene is not coded., Compliance: Failure to meet documentation standards., Data Quality: Inaccurate representation of clinical severity.

Mitigation Strategy

Ensure intraoperative findings confirm gangrene if present.

Impact

Failure to document obstruction can lead to incorrect coding.

Mitigation Strategy

Ensure all symptoms and imaging findings are documented.

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

Documentation Templates for Epigastric Hernia

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

Pre-operative Assessment for Epigastric Hernia

Specialty: General Surgery

Required Elements

  • Location and size of hernia
  • Symptoms of obstruction or gangrene
  • Imaging results
  • History of prior hernia repairs

Example Documentation

Patient presents with a 3 cm epigastric hernia, reducible, no signs of obstruction. CT confirms absence of bowel involvement.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Epigastric hernia noted.
Good Documentation Example
3 cm epigastric hernia, reducible, no obstruction. CT confirms absence of bowel involvement.
Explanation
The good example provides specific details on size, reducibility, and imaging confirmation, supporting accurate coding.

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

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