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K43.6
ICD-10-CM
Incarcerated Ventral Hernia

Find comprehensive information on incarcerated ventral hernia, including clinical documentation tips, ICD-10-CM diagnosis codes (K43), CPT repair codes, and healthcare guidelines. Learn about symptoms, complications, and treatment options for incarcerated hernias. This resource is designed for physicians, coders, and healthcare professionals seeking accurate and up-to-date information on ventral hernia incarceration. Explore best practices for documenting incarcerated ventral hernias and ensure proper coding for reimbursement.

Also known as

Obstructed Ventral Hernia
Strangulated Ventral Hernia

Diagnosis Snapshot

Key Facts
  • Definition : Intestinal loop trapped in abdominal wall defect, causing obstruction.
  • Clinical Signs : Painful, tender bulge, nausea, vomiting, possible bowel obstruction.
  • Common Settings : Emergency room, acute care surgery clinic, general surgery practice.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC K43.6 Coding
K40-K46

Hernia

Covers various types of hernias, including ventral hernias.

K43

Ventral hernia

Specifically designates ventral hernias, excluding umbilical.

K43.1

Incarcerated ventral hernia

Identifies ventral hernias that are incarcerated or obstructed.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the incarcerated ventral hernia reducible?

  • Yes

    Code K43.1, Incarcerated ventral hernia, reducible

  • No

    Is there gangrene or obstruction?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Incarcerated ventral hernia
Strangulated ventral hernia
Reducible ventral hernia

Documentation Best Practices

Documentation Checklist
  • Hernia, ventral, incarcerated: Document location, size, contents
  • Incarcerated hernia: Symptoms (pain, nausea, vomiting) duration
  • Reducibility: Attempts and outcome documented. Surgical plan?
  • Imaging: Type, findings (ischemia, obstruction) specified
  • ICD-10: K43.1, CPT: Consult, surgery codes as appropriate

Coding and Audit Risks

Common Risks
  • Unspecified Location

    Coding ventral hernia without specifying location (e.g., epigastric, umbilical) leads to inaccurate DRG assignment and claim denials. CDI crucial for clarification.

  • Incarceration vs. Obstruction

    Miscoding incarceration as obstruction or vice versa impacts reimbursement. Audits focus on documentation supporting the specific diagnosis. CDI queries essential.

  • Missing Complication Codes

    Failing to code associated complications (e.g., gangrene, perforation) understates severity. Coding audits reveal these missed opportunities. CDI improves capture.

Mitigation Tips

Best Practices
  • Document incarceration signs: pain, irreducibility, obstruction.
  • Code hernia type, location, and incarceration using ICD-10-CM guidelines.
  • Query physician for incarceration clarity for accurate CDI and coding.
  • Ensure proper coding for reimbursement and compliance with payer rules.
  • Timely surgical intervention reduces strangulation risk, document necessity.

Clinical Decision Support

Checklist
  • Hx/PE: Localized abdominal pain, bulge, nausea/vomiting
  • Imaging (CT or US): Confirm hernia, bowel obstruction
  • Labs: Elevated WBC, metabolic derangements
  • Assess for strangulation: Severe pain, skin changes
  • Surgical consult: Expedite if strangulation suspected

Reimbursement and Quality Metrics

Impact Summary
  • Incarcerated Ventral Hernia: Reimbursement and Quality Metrics Impact Summary
  • Keywords: ventral hernia repair, CPT codes, ICD-10 K43, medical billing, reimbursement rates, quality reporting, hospital quality metrics, surgical complications, readmission rates, healthcare costs
  • Impact 1: Higher reimbursement due to complexity. Accurate coding crucial.
  • Impact 2: Increased risk of complications impacting quality scores.
  • Impact 3: Potential for higher readmission rates affecting hospital penalties.
  • Impact 4: Elevated resource utilization impacting overall healthcare costs.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code K40.31 for incarcerated
  • Document incarceration clearly
  • Specify site, size if known
  • Query physician if unclear
  • Check for obstruction codes

Documentation Templates

Patient presents with complaints consistent with an incarcerated ventral hernia.  Symptoms include localized abdominal pain, a palpable bulge that cannot be reduced manually, nausea, and vomiting.  The patient reports the hernia became irreducible [ timeframe - e.g., earlier today, two days ago] and the pain progressively worsened.  Physical examination reveals a tense, tender, and non-reducible ventral hernia at the [ location - e.g., umbilical, epigastric, incisional] site.  Bowel sounds are [ present/absent/hyperactive/hypoactive].  Signs of intestinal obstruction such as abdominal distension, high-pitched bowel sounds, or obstipation may be present.  Differential diagnosis includes other causes of abdominal pain such as bowel obstruction, abdominal wall abscess, and soft tissue masses.  Computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast is ordered to evaluate the contents of the hernia sac, assess for bowel obstruction, and rule out strangulation.  Surgical consultation is obtained for definitive management of the incarcerated ventral hernia.  The patient's condition is explained, and the risks and benefits of surgical repair are discussed.  Informed consent is obtained for hernia repair.  The patient is admitted for observation and preoperative management, including intravenous fluids, pain control, and bowel rest.  Preoperative labs are drawn.  The diagnosis of incarcerated ventral hernia is made based on clinical findings and imaging results.  ICD-10 code K43.1 is assigned.  CPT codes for the surgical repair will be determined based on the operative approach and findings.


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