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ICD-10 Guide
ICD-10 CodesK45.0

K45.0

Billable

Other specified abdominal hernia with obstruction, without gangrene

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

Code Description

ICD-10 K45.0 is a billable code used to indicate a diagnosis of other specified abdominal hernia with obstruction, without gangrene.

Key Diagnostic Point:

K45.0 refers to other specified abdominal hernia with obstruction, without gangrene. This condition occurs when a portion of the intestine or other abdominal contents protrudes through a defect in the abdominal wall, leading to obstruction. The hernia may not be visible externally, making diagnosis challenging. Common sites for these hernias include the inguinal, umbilical, and incisional areas. Clinically, patients may present with symptoms such as abdominal pain, nausea, vomiting, and signs of bowel obstruction. The obstruction can lead to severe complications if not addressed promptly, although the absence of gangrene indicates that the blood supply to the affected area remains intact. Diagnosis typically involves a thorough physical examination, imaging studies such as ultrasound or CT scans, and a review of the patient's medical history. Treatment often requires surgical intervention to repair the hernia and relieve the obstruction, emphasizing the need for careful monitoring and follow-up to prevent recurrence.

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, with varying techniques based on hernia type.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires differentiation from other hernia codes and conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of hernia type or obstruction severity.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results.
  • Billing challenges: Denials may arise from insufficient documentation or incorrect code selection.

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 K45.0 lies in its potential to cause serious complications if left untreated, impacting patient health outcomes. Understanding the epidemiology of abdominal hernias can inform healthcare providers about population health trends and resource allocation. Quality measures related to timely surgical intervention and follow-up care are essential for improving healthcare utilization patterns and reducing the incidence of complications associated with hernias.

ICD-9 vs ICD-10

The clinical significance of K45.0 lies in its potential to cause serious complications if left untreated, impacting patient health outcomes. Understanding the epidemiology of abdominal hernias can inform healthcare providers about population health trends and resource allocation. Quality measures related to timely surgical intervention and follow-up care are essential for improving healthcare utilization patterns and reducing the incidence of complications associated with hernias.

Reimbursement & Billing Impact

reimbursement and minimize audit risks.

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 K45.0?

K45.0 encompasses abdominal hernias that are not classified elsewhere, specifically those causing obstruction without gangrene. This includes hernias that may not be externally visible and require imaging for diagnosis.

When should K45.0 be used instead of related codes?

K45.0 should be used when the hernia is specified as obstructive and does not involve gangrene. It is important to differentiate from codes that specify the type of hernia or those indicating gangrenous conditions.

What documentation supports K45.0?

Documentation should include a detailed clinical assessment, imaging results confirming the obstruction, and notes on the patient's symptoms and treatment plan. Surgical reports post-intervention are also critical.