Pediatric Coding Alert

You’ll say goodbye to code 553.1 effective Oct. 1, 2014.

Umbilical hernias are fairly common in infants, and occur when part of the child’s intestine protrudes through an opening in his abdominal muscles. Parents who see a protruding navel may bring their child into see the pediatrician showing concern about the condition, but in most cases, these conditions resolve on their own within a year or so.

Fortunately for pediatricians, when the ICD-10 code set takes over next year, you won’t have disruption in your coding requirements, since three new codes will replace the three existing umbilical hernia codes.

ICD-9 Coding Rules: Under ICD-9 rules, you have one code to report when a patient suffers from an uncomplicated umbilical hernia—code 553.1 (Umbilical hernia). You currently put this code on your claim to describe the patient’s condition, and typically no additional codes are required unless the patient has other complications accompanying the umbilical hernia. If the patient has an umbilical hernia with obstruction, you’d report 552.1 (Umbilical hernia with obstruction), and if it is accompanied by gangrene, you report 551.1 (Umbilical hernia with gangrene).

ICD-10 Changes: When the ICD-10 transition takes place, you will still have one code to report uncomplicated umbilical hernia (K42.9, Umbilical hernia without obstruction or gangrene), and your overall umbilical hernia coding options will comprise three codes. If the patient has an obstruction (even if that obstruction was caused by the umbilical hernia), you’ll report K42.0 (Umbilical hernia with obstruction, without gangrene), but only if no gangrene is present.

If the umbilical hernia is accompanied by gangrene, code K42.1 (Umbilical hernia with gangrene) will be your best bet, whether or not the patient has an obstruction.

Most umbilical hernias seen in pediatric practices have no obstruction or gangrene, and in those cases, you’ll report K42.9.

Documentation: As in the past, you’ll have to be able to identify whether the patient had an obstruction or gangrene related to the umbilical hernia. Your code choice will hinge on these facts, so the documentation should clearly spell out whether an obstruction or gangrene was present.

Coder Tips: If you currently list 553.1 on your superbills, you’ll have to replace it under ICD-10.