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v1.0.0
ICD-10 Guide
DiagnosesSpigelian Hernia

Spigelian Hernia

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

PRIMARY SPECIALTYGeneral Surgery
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Spigelian Hernia?
Essential facts and insights about Spigelian Hernia

Key Clinical Considerations:

  • Pain or discomfort in the lower abdomen, particularly lateral to the rectus muscle
  • Ultrasound or CT scan showing a defect in the Spigelian fascia
  • Palpable mass in the lower abdominal quadrant during physical examination

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including symptoms and duration
  • Physical examination findings detailing the location and size of the hernia
  • Imaging results confirming the diagnosis

Coding Guidelines

Usage Guidelines & Examples

  • Follow guidelines for hernia coding to avoid miscoding.
  • Common errors include misidentifying the hernia type.

Code Exclusions

Important Exclusions

  • Inguinal hernia, umbilical hernia
  • Other abdominal wall hernias

Related ICD-10 Codes

Primary Codes
K43.2
Spigelian hernia
Ancillary Codes
CPT 49320
CPT 76700
Differential Codes
K46.9
K43.6
K43.7
from
K43.6
.

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

General Surgery

Specialty Applications

  • Adults, particularly those with risk factors like obesity or previous abdominal surgery
  • General surgery clinics and hospitals

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Document the patient's symptoms, physical exam findings, and imaging results.

Billing considerations?

Ensure accurate coding to reflect the specific type of hernia for proper reimbursement.