General Surgery Coding Alert

Question: Our surgeon met with a 57-year-old patient complaining of severe pain around the umbilical area. The patient reported that she had always had a bulge in this area, but that it had been enlarged for seven years since she had her last child. The surgeon examined the patient and reviewed findings from an abdominal ultrasound and x-ray to diagnose a strangulated umbilical hernia with gangrene. I’m still getting used to ICD-10, and would appreciate some help selecting the best diagnosis code.

Codify Subscriber

Answer: The best code choice for the condition you described is K42.1 (Umbilical hernia with gangrene). You should choose the code based on the gangrene, not based on the strangulation (obstruction), because the ICD-10 code for umbilical hernia with obstruction excludes gangrene (K42.0, Umbilical hernia with obstruction, without gangrene).

Notes for K42.1 indicate that “Hernia with both gangrene and obstruction is classified to hernia with gangrene.” The notes also indicate that you can use this code for either congenital or acquired umbilical hernia, which is important in this case, because it appears that the patient may have had the hernia since birth.