ICD-10 Coding for Periumbilical Hernia(K42.9, K42.0, K42.1)
Complete ICD-10-CM coding and documentation guide for Periumbilical Hernia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Periumbilical Hernia
K42-K43Primary Range
Umbilical and Ventral Hernia
This range includes codes for umbilical hernias, including periumbilical hernias, which are coded under K42.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K42.9 | Umbilical hernia without obstruction or gangrene | Use for uncomplicated periumbilical hernias without obstruction or gangrene. |
|
| K42.0 | Umbilical hernia with obstruction, without gangrene | Use when there is documented bowel obstruction without gangrene. |
|
| K42.1 | Umbilical hernia with gangrene | Use when gangrene is confirmed by surgical findings or imaging. |
|
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 periumbilical hernia
Essential facts and insights about Periumbilical Hernia
Primary ICD-10-CM Codes for periumbilical hernia
Decision Criteria
clinical Criteria
- Presence of a reducible hernia sac without bowel involvement.
documentation Criteria
- Detailed description of hernia type and absence of complications.
Applicable To
- Paraumbilical hernia
Excludes
- Ventral hernia (K43.-)
Clinical Validation Requirements
- Physical examination confirming reducibility
- Imaging showing hernia sac without bowel involvement
Code-Specific Risks
- Risk of undercoding if complications are present but not documented.
Coding Notes
- Ensure documentation specifies 'paraumbilical' or 'periumbilical' to avoid confusion with other hernia types.
K42.0 - Umbilical hernia with obstruction, without gangrene
Use when there is documented bowel obstruction without gangrene.
Excludes
- Umbilical hernia with gangrene (K42.1)
Clinical Validation Requirements
- CT scan showing bowel obstruction
- Symptoms of bowel obstruction such as vomiting or lack of flatus
Coding Notes
Ensure obstruction is confirmed by imaging to avoid compliance issues.
K42.1 - Umbilical hernia with gangrene
Use when gangrene is confirmed by surgical findings or imaging.
Excludes
- Umbilical hernia with obstruction, without gangrene (K42.0)
Clinical Validation Requirements
- Operative note indicating necrotic tissue
- Elevated lactate or WBC levels
Coding Notes
Gangrene must be confirmed by clinical or surgical findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Periumbilical pain
R10.84Differential 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 Periumbilical Hernia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K42.9.
Impact
Clinical: Leads to incorrect treatment planning., Regulatory: Increases risk of audits., Financial: May result in claim denials.
Mitigation Strategy
Use specific terminology like 'paraumbilical'., Detail any complications present.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misclassification may result in compliance audits., Data Quality: Inaccurate data affects patient records and statistics.
Mitigation Strategy
Ensure documentation specifies 'paraumbilical' or 'periumbilical'.
Impact
Failure to document complications can lead to incorrect coding.
Mitigation Strategy
Ensure all complications are clearly documented with supporting evidence.
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 Periumbilical Hernia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Periumbilical Hernia
Use these documentation templates to ensure complete and accurate documentation for Periumbilical Hernia. These templates include all required elements for proper coding and billing.
Surgical Repair of Periumbilical Hernia
Specialty: General SurgeryRequired Elements
- Hernia size and location
- Presence of complications
- Surgical technique used
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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