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v1.0.0
ICD-10 Guide
ICD-10 CodesK43.2

K43.2

Billable

Incisional hernia without obstruction or gangrene

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

Code Description

ICD-10 K43.2 is a billable code used to indicate a diagnosis of incisional hernia without obstruction or gangrene.

Key Diagnostic Point:

K43.2 refers to an incisional hernia without obstruction or gangrene, which occurs when tissue protrudes through a weakened area in the abdominal wall at the site of a previous surgical incision. Clinically, patients may present with a visible bulge in the abdomen, discomfort, or pain, particularly when straining or lifting. The anatomy involved includes the abdominal muscles and the peritoneum, which can become compromised due to surgical trauma, infection, or inadequate healing. Disease progression can lead to complications such as incarceration or strangulation, although these are not present in K43.2. Diagnostic considerations typically involve a physical examination and imaging studies, such as ultrasound or CT scans, to confirm the diagnosis and assess the hernia's size and contents. Early identification and management are crucial to prevent potential complications, making accurate coding essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as imaging may be required for confirmation.
  • Treatment complexity: Moderate, as surgical intervention is often necessary.
  • Documentation requirements: Requires detailed surgical history and physical exam findings.
  • Coding specificity: Specific to incisional hernias without complications.

Audit Risk Factors

  • Common coding errors: Misclassification of hernia type or complications.
  • Documentation gaps: Incomplete surgical history or lack of imaging results.
  • Billing challenges: Potential denials if the hernia is not well-documented.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Incisional hernias are a significant concern in postoperative patients, impacting quality of life and healthcare utilization. They can lead to increased healthcare costs due to the need for surgical repair and potential complications. Understanding the epidemiology of incisional hernias helps in developing preventive strategies and improving surgical techniques, ultimately enhancing patient outcomes.

ICD-9 vs ICD-10

Incisional hernias are a significant concern in postoperative patients, impacting quality of life and healthcare utilization. They can lead to increased healthcare costs due to the need for surgical repair and potential complications. Understanding the epidemiology of incisional hernias helps in developing preventive strategies and improving surgical techniques, ultimately enhancing patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but accurate coding is crucial to avoid denials. Common denials may arise from insufficient documentation or misclassification of the hernia type. Best practices include ensuring that all relevant clinical information is included in the medical record and that the coding reflects the specific nature of the hernia.

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 K43.2?

K43.2 specifically covers incisional hernias that are not obstructed or gangrenous. This includes hernias that develop at the site of a previous surgical incision without any associated complications.

When should K43.2 be used instead of related codes?

K43.2 should be used when the hernia is confirmed to be incisional and without obstruction or gangrene. If there are signs of obstruction or strangulation, codes K43.0 or K43.1 should be considered.

What documentation supports K43.2?

Documentation should include a detailed surgical history, physical examination findings indicating the presence of a hernia, and any imaging studies that confirm the diagnosis.