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ICD-10 Guide
ICD-10 CodesK45.1

K45.1

Billable

Other specified abdominal hernia with gangrene

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

Code Description

ICD-10 K45.1 is a billable code used to indicate a diagnosis of other specified abdominal hernia with gangrene.

Key Diagnostic Point:

K45.1 refers to 'Other specified abdominal hernia with gangrene,' a serious condition characterized by the protrusion of abdominal contents through a defect in the abdominal wall, accompanied by necrosis of the tissue due to compromised blood supply. The clinical presentation may include severe abdominal pain, signs of infection, and systemic symptoms such as fever and tachycardia. The anatomy involved typically includes the abdominal wall and the herniated organ, which may be bowel or omentum. Disease progression can lead to strangulation, where the blood supply to the herniated tissue is cut off, resulting in gangrene. Diagnostic considerations include physical examination, imaging studies such as ultrasound or CT scans, and laboratory tests to assess for infection or metabolic derangements. Prompt diagnosis and intervention are crucial to prevent severe complications, including sepsis and death.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm gangrene.
  • Treatment complexity: Often necessitates surgical intervention and possible resection of necrotic tissue.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise documentation of the hernia type and complications.

Audit Risk Factors

  • Common coding errors: Misclassification of hernia type or failure to document gangrene.
  • Documentation gaps: Incomplete clinical notes regarding the severity and treatment.
  • Billing challenges: Potential denials due to lack of specificity in documentation.

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

K45.1 has significant clinical implications, as abdominal hernias with gangrene can lead to severe morbidity and mortality if not treated promptly. The condition affects a diverse population, particularly older adults and those with comorbidities. Understanding the epidemiology of hernias and their complications can inform healthcare utilization patterns and quality measures aimed at reducing surgical complications and improving patient outcomes.

ICD-9 vs ICD-10

K45.1 has significant clinical implications, as abdominal hernias with gangrene can lead to severe morbidity and mortality if not treated promptly. The condition affects a diverse population, particularly older adults and those with comorbidities. Understanding the epidemiology of hernias and their complications can inform healthcare utilization patterns and quality measures aimed at reducing surgical complications and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of the surgical procedures performed. Common denials may arise from insufficient documentation of gangrene or failure to specify the type of hernia. Best practices include ensuring that all clinical notes are detailed and that imaging studies are clearly referenced in the documentation to support the diagnosis.

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 K45.1?

K45.1 covers abdominal hernias that are specified as having gangrene, which may include strangulated hernias where blood supply is compromised, leading to tissue necrosis.

When should K45.1 be used instead of related codes?

K45.1 should be used when there is clear documentation of gangrene associated with an abdominal hernia, differentiating it from other hernia codes that do not specify complications.

What documentation supports K45.1?

Documentation should include clinical findings of gangrene, imaging results confirming the hernia and its complications, and treatment plans that reflect the urgency of the condition.