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ICD-10 Guide
ICD-10 CodesChapter 11: Diseases of the digestive systemK46

K46

Non-billable

Unspecified abdominal hernia

Chapter 11:Diseases of the digestive system

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

Code Description

ICD-10 K46 is a used to indicate a diagnosis of unspecified abdominal hernia.

Key Diagnostic Point:

K46 refers to unspecified abdominal hernia, a condition characterized by the protrusion of abdominal contents through a defect in the abdominal wall. This can occur in various anatomical locations, including the inguinal, umbilical, and incisional areas. Clinically, patients may present with a palpable bulge, discomfort, or pain, particularly when straining or lifting. The progression of an abdominal hernia can lead to complications such as incarceration or strangulation, which can compromise blood flow to the affected tissue and necessitate urgent surgical intervention. Diagnosis typically involves a thorough physical examination, and imaging studies like ultrasound or CT scans may be utilized to assess the hernia's size and contents. It is essential to differentiate between types of hernias, as treatment approaches may vary significantly based on the hernia's characteristics and associated symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as imaging may be required for accurate diagnosis.
  • Treatment complexity: Varies; may require surgical intervention depending on the hernia's severity.
  • Documentation requirements: Requires detailed clinical notes to support diagnosis and treatment.
  • Coding specificity: Moderate; while K46 is specific, it lacks detail on the hernia type.

Audit Risk Factors

  • Common coding errors: Misclassification of hernia type or failure to specify location.
  • Documentation gaps: Incomplete clinical notes regarding symptoms or physical examination findings.
  • 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 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

Abdominal hernias are prevalent in the population, with significant implications for healthcare utilization. They can lead to complications requiring surgical intervention, impacting patient quality of life and healthcare costs. Understanding the epidemiology of hernias, including risk factors such as obesity and age, is essential for developing effective prevention and management strategies. Quality measures related to hernia repair outcomes can also inform healthcare practices and improve patient care.

ICD-9 vs ICD-10

Abdominal hernias are prevalent in the population, with significant implications for healthcare utilization. They can lead to complications requiring surgical intervention, impacting patient quality of life and healthcare costs. Understanding the epidemiology of hernias, including risk factors such as obesity and age, is essential for developing effective prevention and management strategies. Quality measures related to hernia repair outcomes can also inform healthcare practices and improve patient care.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but generally, surgical interventions for hernias are well-covered. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that all relevant clinical information is included, such as the patient's symptoms and any imaging results, to minimize the risk of denials and ensure proper reimbursement.

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 K46?

K46 encompasses unspecified abdominal hernias, which may include various types such as inguinal, umbilical, or incisional hernias that do not have a specified location or classification.

When should K46 be used instead of related codes?

K46 should be used when the specific type of abdominal hernia is not documented or cannot be determined. If the hernia type is known, more specific codes (e.g., K40, K41) should be utilized.

What documentation supports K46?

Documentation should include a detailed history of the patient's symptoms, physical examination findings, and any imaging studies performed to support the diagnosis of an unspecified abdominal hernia.