ICD-10 Coding for Herniorrhaphy(K40.3)
Complete ICD-10-CM coding and documentation guide for Herniorrhaphy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herniorrhaphy
K40-K46Primary Range
Hernia codes, including inguinal, femoral, umbilical, and other abdominal hernias
These codes cover the various types of hernias that may require surgical repair.
Congenital hernia codes
These codes are used for congenital hernias, which are separate from acquired hernias.
Key Information: ICD-10 code for herniorrhaphy
Essential facts and insights about Herniorrhaphy
Primary ICD-10-CM Code for herniorrhaphy
Decision Criteria
clinical Criteria
- Obstruction without gangrene confirmed by imaging
Applicable To
- Bilateral inguinal hernia with obstruction
Excludes
- Inguinal hernia with gangrene
Clinical Validation Requirements
- CT showing bowel wall thickening
- Oral contrast extravasation
Code-Specific Risks
- Misclassification if gangrene is present
Coding Notes
- Ensure documentation specifies obstruction without gangrene.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
ICD-10-PCS code for open repair of hernia
0B110J4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Bilateral inguinal hernia, with gangrene
K40.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Herniorrhaphy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K40.3.
Impact
Clinical: Ambiguity in surgical site can lead to incorrect treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to incomplete documentation.
Mitigation Strategy
Always specify left or right in the operative note., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding can lead to claim denials or reduced payment., Compliance: Non-compliance with current coding standards., Data Quality: Inaccurate data reporting and tracking.
Mitigation Strategy
Use the updated 2023 CPT codes (49591-49596) for anterior abdominal hernias.
Impact
Incomplete operative notes can lead to coding errors and audits.
Mitigation Strategy
Use standardized templates and checklists to ensure all required elements 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 Herniorrhaphy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herniorrhaphy
Use these documentation templates to ensure complete and accurate documentation for Herniorrhaphy. These templates include all required elements for proper coding and billing.
Operative note for hernia repair
Specialty: General SurgeryRequired Elements
- Defect size
- Hernia location
- Mesh type and placement
- Surgical approach
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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