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ICD-10 Guide
ICD-10 CodesK43.6

K43.6

Billable

Other and unspecified ventral hernia with obstruction, without gangrene

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

Code Description

ICD-10 K43.6 is a billable code used to indicate a diagnosis of other and unspecified ventral hernia with obstruction, without gangrene.

Key Diagnostic Point:

K43.6 refers to other and unspecified ventral hernias with obstruction, without gangrene. Ventral hernias occur when an organ or tissue protrudes through a weak spot in the abdominal wall, typically in the area of the umbilicus or along previous surgical scars. Clinical presentation may include abdominal pain, nausea, vomiting, and signs of bowel obstruction, such as inability to pass gas or stool. The anatomy involved includes the abdominal wall musculature and the peritoneal cavity, where the herniated tissue may obstruct the intestines. Disease progression can lead to complications such as incarceration or strangulation of the hernia, although K43.6 specifically excludes gangrenous cases. Diagnostic considerations include physical examination, imaging studies like ultrasound or CT scans, and assessment of the patient's history. 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 differentiate from other abdominal conditions.
  • Treatment complexity: May involve surgical intervention, which varies based on the hernia's size and symptoms.
  • Documentation requirements: Detailed clinical notes and imaging results are essential for accurate coding.
  • Coding specificity: Requires precise documentation to distinguish from other hernia types.

Audit Risk Factors

  • Common coding errors: Misclassification of the hernia type or failure to document obstruction.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and imaging findings.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis and treatment.

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

The clinical significance of K43.6 lies in its potential to lead to serious complications if not managed promptly. Population health impact includes the prevalence of ventral hernias, which can affect a significant portion of the population, particularly post-surgical patients. Quality measures may focus on timely diagnosis and intervention to prevent complications. Healthcare utilization patterns show that patients with obstructed hernias often require emergency care, leading to increased healthcare costs and resource utilization. Epidemiological considerations highlight the need for awareness and preventive measures in at-risk populations.

ICD-9 vs ICD-10

The clinical significance of K43.6 lies in its potential to lead to serious complications if not managed promptly. Population health impact includes the prevalence of ventral hernias, which can affect a significant portion of the population, particularly post-surgical patients. Quality measures may focus on timely diagnosis and intervention to prevent complications. Healthcare utilization patterns show that patients with obstructed hernias often require emergency care, leading to increased healthcare costs and resource utilization. Epidemiological considerations highlight the need for awareness and preventive measures in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the hernia repair procedure and whether it is performed on an inpatient or outpatient basis. Common denials may arise from insufficient documentation of the obstruction or failure to provide adequate clinical rationale for surgical intervention. Best practices include ensuring all relevant clinical notes, imaging results, and surgical reports are included in the billing submission to support the diagnosis and treatment provided.

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 K43.6?

K43.6 covers ventral hernias that are obstructed but not gangrenous. This includes hernias that may not fit typical classifications, such as those occurring in unusual locations or those that have not been previously documented.

When should K43.6 be used instead of related codes?

K43.6 should be used when there is clear evidence of obstruction without gangrene. If the hernia is reducible or not obstructing the bowel, other codes such as K43.0 may be more appropriate.

What documentation supports K43.6?

Documentation should include a detailed history of symptoms, physical examination findings, imaging results confirming obstruction, and any surgical notes if applicable.