Coding Hernias

This edition of “In the kNOW”  presents information on coding hernias.  Correctly assigning hernia codes requires coders to first determine what type of hernia is being repaired.  A coder must identify if the hernia is inguinal, femoral, incisional, umbilical, ventral, hiatal, etc.  Let’s look at the differences in the types of hernias in more detail.

Source: https://anatomyinnerbody.com/inguinal-hernia-in-females-pictures/inguinal-hernia-in-females-pictures-hernia-repair-abroad-at-affordable-pirce-in-budapest-hungary/

  
A hernia occurs when there is a weakness in muscle or tissue and strain, which causes an organ to bulge through the weakened area.  Straining such as heavy lifting, coughing, and constipation contributes to the occurrence of hernias.  Obesity is another factor that contributes to the development of hernias.

Hernias can occur in many areas of the body, and as illustrated above, often occur in the abdomen. Inguinal hernias appear in the lower abdominal area usually as a result of intestines or fat protruding through the abdominal wall.  Direct inguinal hernias do not enter the inguinal canal, while indirect inguinal hernias do.  Femoral hernias occur in the low part of the abdomen or upper thigh.

Ventral hernia is a term for any hernia that occurs along the midline of the abdominal wall.  There are three types of ventral hernias.  An umbilical hernia occurs at the belly button area. Epigastric hernias occur in the upper abdomen between the umbilicus and the lower sternal area.  Incisional hernias occur where there has been a previous surgical incision.  These hernias arise due to the fact that the previous incision did not totally heal, leaving a weak area, which lends itself to herniation.

Spigelian hernias arise in the lower abdomen fascia between the lateral oblique and rectus muscles.  In ICD-10-CM, spigelian hernias are coded to ventral hernias.

There are hernias that occur in other regions of the body, for example hiatal hernias.  This type of hernia is the result of the top part of the stomach protruding through the diaphragm.  The area of the protrusion is the hole in the diaphragm through which the esophagus passes to connect with the stomach.  If a portion of the stomach bulges into that opening, a hiatal hernia is created.  Also, consider hernias that occur internally in the abdomen.  These hernias may be seen in patients who have had bariatric surgery.  ICD-10-CM directs coders to assign codes for internal or intra-abdominal hernias as abdominal hernias. 

Once the type of hernia has been identified other factors may need to be considered such as:

• Initial vs. recurrent
• Reducible vs. incarcerated/strangulated/obstructed/irreducible (all of which are coded in ICD-10-CM to Hernia, by site, with obstruction)
• Presence of gangrene
• Unilateral vs. bilateral

Coding professionals must be sure to follow the Index entries carefully when assigning hernia codes.  For example, when assigning a code for a bilateral inguinal hernia with obstruction, it could be easy to stop at code K40.30 for inguinal hernia with obstruction.  However, the correct code is actually K40.00, which captures the bilateral component.

After the correct diagnosis has been captured, the coder will turn to assigning the code for hernia repair, which will be discussed in the next installment.

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.