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ICD-10 Guide
ICD-10 CodesK43.9

K43.9

Billable

Ventral hernia without obstruction or gangrene

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

Code Description

ICD-10 K43.9 is a billable code used to indicate a diagnosis of ventral hernia without obstruction or gangrene.

Key Diagnostic Point:

A ventral hernia is characterized by the protrusion of abdominal contents through a defect in the abdominal wall, specifically in the area of the anterior abdominal wall. This condition can occur due to various factors, including congenital defects, surgical scars, or increased intra-abdominal pressure from obesity, pregnancy, or heavy lifting. Clinically, patients may present with a visible bulge in the abdomen, discomfort, or pain, especially when straining or lifting. The hernia is classified as 'without obstruction or gangrene' when there are no signs of bowel obstruction or compromised blood supply to the herniated tissue, which is critical for determining the urgency of surgical intervention. Diagnosis typically involves a physical examination and may include imaging studies such as ultrasound or CT scans to assess the size and contents of the hernia. Disease progression can lead to complications if left untreated, including incarceration or strangulation, necessitating timely surgical repair to prevent serious morbidity.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as diagnosis may require imaging.
  • Treatment complexity: Moderate, with surgical options varying based on hernia size and patient health.
  • Documentation requirements: Requires clear documentation of symptoms and physical findings.
  • Coding specificity: Moderate, as it is essential to differentiate from obstructed or strangulated hernias.

Audit Risk Factors

  • Common coding errors: Misclassification of hernia type or complications.
  • Documentation gaps: Incomplete records of symptoms or physical exam findings.
  • Billing challenges: Denials may occur if surgical necessity 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

Ventral hernias are common, affecting a significant portion of the population, particularly among older adults and those with risk factors such as obesity. The clinical significance lies in the potential for complications if left untreated, which can lead to increased healthcare utilization and costs. Quality measures may include tracking surgical outcomes and patient satisfaction post-repair. Understanding the epidemiology of ventral hernias can help healthcare providers implement preventive strategies and improve patient education regarding risk factors.

ICD-9 vs ICD-10

Ventral hernias are common, affecting a significant portion of the population, particularly among older adults and those with risk factors such as obesity. The clinical significance lies in the potential for complications if left untreated, which can lead to increased healthcare utilization and costs. Quality measures may include tracking surgical outcomes and patient satisfaction post-repair. Understanding the epidemiology of ventral hernias can help healthcare providers implement preventive strategies and improve patient education regarding risk factors.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical procedure performed and the patient's overall health status. Common denials may arise from insufficient documentation of the necessity for surgery or failure to provide adequate clinical evidence of the hernia. Best practices include thorough documentation of the patient's symptoms, physical examination findings, and any imaging studies that support the diagnosis, as well as ensuring that the CPT codes selected align with the services rendered.

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 K43.9?

K43.9 covers ventral hernias that are not obstructed or gangrenous, including umbilical, epigastric, and incisional hernias without complications.

When should K43.9 be used instead of related codes?

K43.9 should be used when there is a clear diagnosis of a ventral hernia without obstruction or gangrene, differentiating it from codes that indicate complications.

What documentation supports K43.9?

Documentation should include a detailed history of symptoms, physical examination findings, and any imaging results that confirm the diagnosis of a ventral hernia without complications.