Hernia Reporting
Under ICD-10-CM, hernia reporting will be easy for coders as it is quite similar to the ICD-9-CM coding. The codes for reporting hernia are found in the chapter “Diseases of the digestive system”.
A Hernia is defined as an organ or fatty tissue that has pushed through a weak spot in a surrounding muscle or connective tissue. This connective tissue is called fascia. Hernias are caused because of pressure and an opening of muscle or fascia. The pressure pushes the organ or tissue through that opening. The weak muscle is present at birth but occurs later in life. Weakening of the muscle can be due to obesity, malnutrition and smoking. An increase in pressure in the abdomen causes hernia. Constipation or diarrhea, coughing, sneezing, lifting heavy objects are other causes.
Hernia Types:
- Inguinal or inner groin hernia: There is a protrusion of intestine or bladder through the abdominal wall or in the groin.
- Incisional hernia: These are the ones that result from an incision. This is mostly found in elders or obese people.
- Femoral hernia. Also called as outer groin hernia: In this, the intestine enters through a canal which carries the femoral artery to the upper thigh.
- Umbilical hernia or belly button: A part of the small intestine passes through the abdominal wall near the navel. It is very common in newborns. It also affects obese women.
- Hiatal or upper stomach hernia: This happens when there is squeezing of upper stomach through the hiatus.
The codes for hernia are structured in the ICD-10-CM as:
- Inguinal hernia : K40.This is categorized as:
- Bilateral inguinal hernia, with obstruction, without gangrene K40.0
- Bilateral inguinal hernia, with gangrene K40.1
- Bilateral inguinal hernia, without obstruction or gangrene K40.2
- Unilateral inguinal hernia, with obstruction, without gangrene K40.3.This is further divided on the basis of laterality and presentation:
? Unilateral inguinal hernia, with obstruction, without gangrene, not recurrent K40.30
? Unilateral inguinal hernia, with obstruction, without gangrene, recurrent K40.31
- Unilateral inguinal hernia, with gangrene K40.4
- Unilateral inguinal hernia, without obstruction or gangrene K40.9
- Femoral hernia : K41
Umbilical hernia : K42
Ventral hernia : K43.They are subcategorized as incisional, parastomal or unspecified hernia.
- Incisional hernia with obstruction, without gangrene K43.0
- Parastomal hernia without obstruction or gangrene K43.5
- Other and unspecified ventral hernia with gangrene K43.6.Examples that come under other and unspecified ventral hernias are:
- Epigastric hernia
- Hypogastric hernia
- Midline hernia
- Spigelian hernia
- Subxiphoid hernia
- Diaphragmatic hernia : K44
- Acquired hiatal hernia
- Esophageal hernia
- Sliding hernia
- Paraesophageal hernia
- There is an exception to this category, congenital diaphragmatic hernias are reported with code Q79.0 and
Congenital hiatal hernias are coded to Q40.1.These two codes are found in chapter 16 named “Congenital malformations, deformations and chromosomal abnormalities”.
- Other abdominal hernia : K45
- Unspecified abdominal hernia : K46
From the above classification, it is clear how the documentation should be for reporting hernia codes.
- Firstly, whether the inguinal hernia is unilateral or bilateral.
- The presence and absence of complications:
- Gangrene / Gangrene with Obstruction.
- Obstruction
- Without the mention of obstruction or gangrene.
- Recurrent or not recurrent.
No additional digits are needed to be added to the hernia codes in ICD-10-CM. Mostly, all the hernia codes has the code combination provided in the description of each code.