ICD-10 Coding for Groin Hernia(K40.90, K40.31)
Complete ICD-10-CM coding and documentation guide for Groin Hernia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Groin Hernia
K40-K41Primary Range
Hernia of the abdominal cavity
This range includes codes for inguinal and femoral hernias, which are the most common types of groin hernias.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K40.90 | Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent | Use when documenting a unilateral inguinal hernia without complications. |
|
| K40.31 | Incarcerated recurrent inguinal hernia | Use when the patient has a recurrent inguinal hernia that is incarcerated. |
|
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 groin hernia
Essential facts and insights about Groin Hernia
Primary ICD-10-CM Codes for hernia groin
Decision Criteria
clinical Criteria
- Presence of a reducible groin bulge without symptoms of obstruction
Applicable To
- Unilateral inguinal hernia without obstruction
Clinical Validation Requirements
- Physical examination showing reducible groin bulge
- No signs of obstruction or gangrene
Code-Specific Risks
- Ensure laterality is documented to avoid unspecified coding.
Coding Notes
- Ensure documentation specifies whether the hernia is reducible or incarcerated.
K40.31 - Incarcerated recurrent inguinal hernia
Use when the patient has a recurrent inguinal hernia that is incarcerated.
Applicable To
- Recurrent inguinal hernia with incarceration
Excludes
- Strangulated hernia (K40.41)
Clinical Validation Requirements
- Physical examination indicating non-reducible hernia
- History of previous hernia repair
Coding Notes
Document the history of prior hernia repair and current incarceration status.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Groin Hernia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K40.90.
Impact
Clinical: Inaccurate surgical records, Regulatory: Non-compliance with coding guidelines, Financial: Potential loss of reimbursement for mesh use
Mitigation Strategy
Standardize operative note templates to include mesh details, Educate surgical teams on documentation requirements
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases accuracy of health data records.
Mitigation Strategy
Always use the specific code for left or right when documented.
Impact
Failure to code the correct laterality can lead to audit flags.
Mitigation Strategy
Implement double-check systems for laterality documentation.
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 Groin Hernia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Groin Hernia
Use these documentation templates to ensure complete and accurate documentation for Groin Hernia. These templates include all required elements for proper coding and billing.
Inguinal Hernia Repair
Specialty: General SurgeryRequired Elements
- Hernia type and laterality
- Surgical approach
- Use of mesh
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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