ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesK43.0

K43.0

Billable

Incisional hernia with obstruction, without gangrene

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K43.0 is a billable code used to indicate a diagnosis of incisional hernia with obstruction, without gangrene.

Key Diagnostic Point:

K43.0 refers to an incisional hernia with obstruction, without gangrene, which occurs when a portion of the intestine protrudes through a defect in the abdominal wall at the site of a previous surgical incision. Clinically, patients may present with symptoms such as abdominal pain, nausea, vomiting, and signs of bowel obstruction, including distension and constipation. The anatomy involved includes the abdominal wall musculature and the peritoneal cavity, where the hernia sac can contain loops of bowel or omentum. Disease progression can lead to complications such as strangulation if the blood supply to the herniated tissue is compromised, although K43.0 specifically indicates the absence of gangrene. Diagnostic considerations include physical examination, imaging studies like ultrasound or CT scans, and assessment of bowel function. Timely diagnosis and intervention are crucial to prevent further complications and manage symptoms effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm obstruction.
  • Treatment complexity: Surgical intervention is often necessary, which can vary based on the patient's overall health.
  • Documentation requirements: Detailed clinical notes and imaging results are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other types of hernias and complications.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of hernia or omission of obstruction details.
  • Documentation gaps: Lack of clear evidence of obstruction or surgical history.
  • Billing challenges: Potential denials if documentation does not support the necessity of surgical intervention.

Specialty Focus

Medical Specialties

General Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of K43.0 lies in its potential to lead to serious complications if not addressed promptly. Population health impact includes a notable prevalence of incisional hernias following abdominal surgeries, which can affect healthcare utilization patterns due to the need for surgical repair. Quality measures may focus on timely intervention and postoperative outcomes, while epidemiological considerations highlight the importance of monitoring surgical complications in at-risk populations.

ICD-9 vs ICD-10

The clinical significance of K43.0 lies in its potential to lead to serious complications if not addressed promptly. Population health impact includes a notable prevalence of incisional hernias following abdominal surgeries, which can affect healthcare utilization patterns due to the need for surgical repair. Quality measures may focus on timely intervention and postoperative outcomes, while epidemiological considerations highlight the importance of monitoring surgical complications in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical procedure and the patient's health status. Common denials may arise from insufficient documentation of the obstruction or failure to provide evidence of prior surgical history. Best practices include thorough documentation of clinical findings, imaging studies, and the rationale for surgical intervention to support claims.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K43.0?

K43.0 specifically covers incisional hernias that have become obstructed but do not exhibit signs of gangrene. This includes cases where the hernia sac contains bowel that is obstructed but still viable.

When should K43.0 be used instead of related codes?

K43.0 should be used when there is clear evidence of an incisional hernia causing obstruction without gangrene. If gangrene is present, K43.2 should be used instead.

What documentation supports K43.0?

Documentation should include a detailed history of the surgical procedure leading to the hernia, clinical findings indicating obstruction, imaging results, and any treatment plans or surgical notes.