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ICD-10 Guide
ICD-10 CodesK43.7

K43.7

Billable

Other and unspecified ventral hernia with gangrene

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

Code Description

ICD-10 K43.7 is a billable code used to indicate a diagnosis of other and unspecified ventral hernia with gangrene.

Key Diagnostic Point:

K43.7 refers to other and unspecified ventral 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 ventral hernia typically occurs in the anterior abdominal wall, where the layers of muscle and fascia are weakened, allowing for herniation. Clinical presentation may include a palpable bulge, pain, and signs of bowel obstruction or strangulation. As the condition progresses, the herniated tissue can become ischemic, leading to gangrene, which is a life-threatening emergency requiring immediate surgical intervention. Diagnostic considerations include physical examination, imaging studies such as ultrasound or CT scans, and laboratory tests to assess for infection or metabolic derangements. Early recognition and treatment are crucial to prevent complications such as sepsis or peritonitis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification of the type of hernia or failure to document the presence of gangrene.
  • Documentation gaps may arise from insufficient detail regarding the clinical presentation and treatment plan.
  • Billing challenges often involve denials related to the lack of specificity in documentation or failure to meet medical necessity criteria.

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 K43.7 lies in its potential to lead to severe complications, including sepsis and death, if not promptly addressed. The population health impact is notable, as ventral hernias are common, and the progression to gangrene can increase healthcare utilization due to emergency interventions and prolonged hospital stays. Quality measures should focus on timely diagnosis and treatment to improve patient outcomes and reduce morbidity associated with this condition.

ICD-9 vs ICD-10

The clinical significance of K43.7 lies in its potential to lead to severe complications, including sepsis and death, if not promptly addressed. The population health impact is notable, as ventral hernias are common, and the progression to gangrene can increase healthcare utilization due to emergency interventions and prolonged hospital stays. Quality measures should focus on timely diagnosis and treatment to improve patient outcomes and reduce morbidity associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure performed aligns with the diagnosis and that all documentation supports the medical necessity of the treatment. Common denials may arise from insufficient detail in the clinical notes or failure to demonstrate the urgency of the condition. Coders should ensure that all relevant CPT codes are accurately linked to K43.7 to avoid billing discrepancies.

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 K43.7?

K43.7 encompasses cases of ventral hernias that have progressed to gangrene, which may include hernias that are incarcerated or strangulated, leading to tissue necrosis. It is crucial to document the clinical findings that indicate the presence of gangrene.

When should K43.7 be used instead of related codes?

K43.7 should be used when there is clear evidence of gangrene associated with a ventral hernia. If the hernia is present without gangrene, codes such as K43.0 or K43.1 should be utilized instead.

What documentation supports K43.7?

Documentation should include a detailed clinical assessment indicating the presence of gangrene, imaging studies confirming the diagnosis, and a treatment plan that outlines the surgical intervention required to address the hernia and gangrene.