Anesthesia Coding Alert

Tip: You’ll still need to watch for the presence or absence of gangrene.

When your anesthesia provider is involved in cases to correct umbilical hernias after ICD-10 is implemented, many things (such as using the presence or absence of obstruction or gangrene as your basis for code choice) will remain the same. Other factors, however, could have you searching for more details in order to assign the correct diagnosis. 

ICD-9 approach: While reporting a diagnosis of umbilical hernia, you currently have three choices based on whether the surgeon identifies the presence or absence of any obstruction or gangrene. Those options are:

• 551.1 (Umbilical hernia with gangrene)
• 552.1 (Umbilical hernia with obstruction)
• 553.1 (Umbilical hernia without obstruction or gangrene). 

ICD-10 changes: When you begin using ICD-10 codes on Oct.1, 2014, you’ll report a diagnosis of umbilical hernia with K42 (Umbilical hernia). Again, depending on the presence or absence of obstruction or gangrene, you have three code choices to more accurately report the condition. You can report a diagnosis of umbilical hernia with these three codes in ICD-10:

• K42.0 (Umbilical hernia with obstruction, without gangrene)
• K42.1 (Umbilical hernia with gangrene)
• K42.9 (Umbilical hernia without obstruction or gangrene)

If you look at the descriptor to K42.0, you’ll notice that it’s more specific than its ICD-9 predecessor (552.1) because it is specific for umbilical hernia with obstruction and specifically mentions that there is no gangrene.

Pay attention: Diagnosis K42.0 could get a lot of use in the future. This is the code you’ll report for diagnoses of incarcerated umbilical hernia, irreducible umbilical hernia, or strangulated umbilical hernia when no gangrene is mentioned in the documentation. You’ll also turn to K42.9 when the diagnosis is umbilical hernia NOS.

Documentation: The anesthesia provider might not know the specific type of umbilical hernia to document it in his or her record. The surgeon’s notes should have all the details you need, however (such as whether gangrene or obstruction is present), so work with the surgical coders to ensure you’re correctly reporting the situation