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ICD-10 Guide
ICD-10 CodesK46.0

K46.0

Billable

Unspecified abdominal hernia with obstruction, without gangrene

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

Code Description

ICD-10 K46.0 is a billable code used to indicate a diagnosis of unspecified abdominal hernia with obstruction, without gangrene.

Key Diagnostic Point:

K46.0 refers to an unspecified abdominal hernia with obstruction, without gangrene. Abdominal hernias occur when an organ or tissue protrudes through a weak spot in the abdominal wall. This condition can lead to obstruction, where the herniated tissue blocks the passage of contents through the intestines, causing symptoms such as abdominal pain, nausea, vomiting, and constipation. The anatomy involved typically includes the abdominal wall and the gastrointestinal tract, particularly the intestines. Disease progression can vary; if left untreated, an obstructed hernia may lead to complications such as strangulation, where blood supply to the herniated tissue is compromised, but in this case, gangrene is not present. Diagnostic considerations include physical examination, imaging studies like ultrasound or CT scans, and patient history to assess the severity of symptoms and the presence of obstruction. Timely diagnosis and intervention are crucial to prevent further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm obstruction.
  • Treatment complexity: Surgical intervention may be necessary, depending on the severity.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires accurate identification of the type of hernia and its complications.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of hernia or its complications.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and imaging results.
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis.

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

K46.0 has significant clinical implications as untreated obstructed hernias can lead to severe complications, including bowel ischemia. Understanding the epidemiology of hernias can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include tracking surgical outcomes and patient recovery times, which can influence healthcare utilization patterns and resource allocation.

ICD-9 vs ICD-10

K46.0 has significant clinical implications as untreated obstructed hernias can lead to severe complications, including bowel ischemia. Understanding the epidemiology of hernias can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include tracking surgical outcomes and patient recovery times, which can influence healthcare utilization patterns and resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical procedure if performed, as well as the need for pre-operative imaging. Common denials may arise from insufficient documentation of the obstructive nature of the hernia or failure to specify the type of hernia. Best practices include ensuring that all clinical notes are complete and that imaging studies are clearly linked to 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 K46.0?

K46.0 covers unspecified abdominal hernias that present with obstruction but do not involve gangrene. This includes various types of hernias such as inguinal, femoral, and umbilical hernias that have become obstructed.

When should K46.0 be used instead of related codes?

K46.0 should be used when there is an obstruction due to an unspecified abdominal hernia without gangrene. If gangrene is present, K46.1 should be used. Accurate documentation of symptoms and imaging findings is critical for code selection.

What documentation supports K46.0?

Documentation for K46.0 should include a detailed clinical assessment, imaging results confirming the obstruction, and a clear description of the hernia type. Notes should also reflect the absence of gangrene and any relevant patient history.