Ventral hernia without obstruction or gangrene 1 K43.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 The 2021 edition of ICD-10-CM K43.9 became effective on October 1, 2020. 3 This is the American ICD-10-CM version of K43.9 - other international versions of ICD-10 K43.9 may differ.
If mesh implantation is performed with any other open hernia repair (inguinal, epigastric, umbilical, femoral), do not report +49568 because those codes include mesh placement. Mesh is also included as a part of laparoscopic repair.
Using Biodesign during ventral or incisional hernia repair typically involves coding for the repair and the appropriate C-code (when care is provided to Medicare patients in the hospital outpatient setting) to describe the device.
Ventral hernias include umbilical hernia, incisional, epigastric, and spigelian hernias. ICD-10-CM K43.9 is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 393 Other digestive system diagnoses with mcc 394 Other digestive system diagnoses with cc
81 for Encounter for surgical aftercare following surgery on specified body systems is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
89.
ICD-10-CM Code for Encounter for surgical aftercare following surgery on the digestive system Z48. 815.
ICD-10 code K43. 9 for Ventral hernia without obstruction or gangrene is a medical classification as listed by WHO under the range - Diseases of the digestive system .
815 - Encounter for surgical aftercare following surgery on the digestive system | ICD-10-CM.
Other specified postprocedural statesICD-10 code Z98. 89 for Other specified postprocedural states is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Use Z codes to code for surgical aftercare. Z47. 89, Encounter for other orthopedic aftercare, and. Z47.
Aftercare visit codes are assigned in situations in which the initial treatment of a disease has been performed but the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease.
Follow-up. The difference between aftercare and follow-up is the type of care the physician renders. Aftercare implies the physician is providing related treatment for the patient after a surgery or procedure. Follow-up, on the other hand, is surveillance of the patient to make sure all is going well.
Hernia repairCPT codeDescriptor49560Repair initial incisional or ventral hernia; reducible49561Repair initial incisional or ventral hernia; incarcerated or strangulated49565Repair recurrent incisional or ventral hernia; reducible49566Repair recurrent incisional or ventral hernia; incarcerated or strangulated39 more rows•Apr 1, 2017
The goal of ventral hernia surgery is to repair the hole/defect in the abdominal wall so that the intestine and other abdominal tissue cannot bulge through the wall again. The surgery often restores the tone and shape of the abdominal wall by repairing the hole and bringing the muscles back to their normal position.
A ventral hernia occurs when a weak spot in the abdomen enables abdominal tissue or an organ (such as an intestine) to protrude through a cavity muscle area. These hernias are visibly identified by a bulge in the belly area.
Hernia repairCPT codeDescriptor49560Repair initial incisional or ventral hernia; reducible49561Repair initial incisional or ventral hernia; incarcerated or strangulated49565Repair recurrent incisional or ventral hernia; reducible49566Repair recurrent incisional or ventral hernia; incarcerated or strangulated39 more rows•Apr 1, 2017
The goal of ventral hernia surgery is to repair the hole/defect in the abdominal wall so that the intestine and other abdominal tissue cannot bulge through the wall again. The surgery often restores the tone and shape of the abdominal wall by repairing the hole and bringing the muscles back to their normal position.
About Ventral Hernias A ventral hernia occurs when a weak spot in the abdomen enables abdominal tissue or an organ (such as an intestine) to protrude through a cavity muscle area. These hernias are visibly identified by a bulge in the belly area.
Incarcerated ventral hernia was defined as irreducible hernia associated with symptoms of bowel obstruction, yet with no compromise of the blood supply of the bowel. Strangulated hernia presented with partial or complete interruption of the blood supply of the intestine.
This is the official approximate match mapping between ICD9 and ICD10, as provided by the General Equivalency mapping crosswalk. This means that while there is no exact mapping between this ICD10 code Z48.815 and a single ICD9 code, V58.75 is an approximate match for comparison and conversion purposes.
ICD-10-CM Code for Encounter for surgical aftercare following surgery on specified body systems Z48.81 ICD-10 code Z48.81 for Encounter for surgical aftercare following surgery on specified body systems is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Note. Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'.This can arise in two main ways:
A hernia caused by weakness of the anterior abdominal wall due to midline defects, previous incisions, or increased intra-abdominal pressure. Ventral hernias include umbilical hernia, incisional, epigastric, and spigelian hernias.
The 2022 edition of ICD-10-CM K43.9 became effective on October 1, 2021.
Hernia with both gangrene and obstruction is classified to hernia with gangrene. A hernia caused by weakness of the anterior abdominal wall due to midline defects, previous incisions, or increased intra-abdominal pressure. Ventral hernias include umbilical hernia, incisional, epigastric, and spigelian hernias.
Aftercare codes are found in categories Z42-Z49 and Z51. Aftercare is one of the 16 types of Z-codes covered in the 2012 ICD-10-CM Official Guidelines and Reporting. Aftercare visit codes cover situations occurring when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or care for the long-term consequences of the disease.
Aftercare following explantation of a joint prosthesis is reported with a code from category Z47, denoting orthopedic aftercare. Aftercare following explantation of a joint prosthesis (Z47.3-) may be reported for a staged procedure or an encounter for evaluation of planned insertion of a new joint prosthesis following prior explantation of a joint prosthesis. In ICD-10-CM, aftercare for explantation of a joint prosthesis is specific to site.
Aftercare for injuries is reported with a V-code in ICD-9-CM. However, aftercare of injuries in ICD-10-CM is captured with the seventh character “D,” specifically denoting routine care following most injuries. For fractures, additional seventh characters for subsequent encounters apply, depending on whether the fracture is open or closed and whether the healing is routine or delayed, with nonunion or malunion.
Codes for encounters for antineoplastic radiation, chemotherapy and immunotherapy (Z51.0, Z51.1-) are assigned if the sole reason for the encounter is antineoplastic therapy – even if the patient still has the neoplastic disease.
When the reason for an encounter is aftercare following a procedure or injury, the 2012 ICD-10-CM Official Guidelines and Reporting should be consulted to ensure that the correct code is assigned. Codes for reporting most types of aftercare are found in Chapter 21. However, aftercare related to injuries is reported with codes from Chapter 19, using seventh-character extensions to identify the service as aftercare.
Aftercare codes should be used in conjunction with other aftercare codes, diagnosis codes and/or other categories of Z-codes to provide better detail on the specifics of the aftercare encounter/visit, unless otherwise directed by the classification.
Reason for encounter: Aftercare for traumatic fracture is reported with code S82.224D, Nondisplaced transverse fracture of shaft of right tibia, subsequent encounter for closed fracture with routine healing.
Voilà, you’re done. If it’s open, you have a bit more work to do, so turn to code range 49491–49611 for open hernia repair.
Another factor that determines correct coding is the clinical presentation of the hernia. When the contents of the hernia sac return to their normal location spontaneously or by gentle manipulation, the hernia is considered reducible. While moving the contents may make the hernia appear smaller or disappear, the weakened tissue still needs to be repaired to avoid recurrence of the hernia.
Add-on code +49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) can only be reported separately with codes 49560–49566 for incisional or ventral hernia repair and debridement codes 11040–11006.
Do not use add-on code +11008 Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure) to report mesh removal during hernia repair. Although it describes mesh removal, this code can only be used with 10180 Incision and drainage, complex, postoperative wound infection and debridement codes 11004–11006.
Surgeons will often place a piece of prosthetic mesh to help strengthen the area of the abdominal wall being repaired and provide additional support to the damaged tissue. Hernia mesh is used in 90 percent of hernia surgeries and, when used and placed correctly, reduces the risk of recurrence.
Surgery is directed at permanently closing off the orifice through which the abdominal contents protrude, after returning them to the abdominal cavity. Usually, an incision is made over the hernia and the hernia sac is dissected from any surrounding structures.
Incarcerated hernias are more worrisome because they run a greater likelihood of becoming strangulated, which is when the blood supply to an incarcerated hernia is cut off as the vessels pass through the neck of the hernia. This is dangerous, due to the risk of gangrene when tissues die, and can be life-threatening if it isn’t treated.
Procedures were defined by Current Procedural Terminology (CPT®) codes 49560, 49561, 49565, or 49566 (repair initial or recurrent hernia, either incarcerated or strangulated), 49652–49657 (laparoscopy, repair, ventral/ incisional hernia, either incarcerated/strangulated) or 49659 (unlisted laparoscopic hernia repair). Patients were required to have a minimum of 12 months of continuous insurance coverage following the index event, except for death (as identified by inpatient discharge status).
The Ventral Hernia Working Group (VHWG) developed a grading system to categorize patients based on risk of surgical site occurrences, with recommendations to guide
Any downstream episode with CPT 11008 OR, in the synthetic mesh study arm, any downstream episode with ICD9 diagnosis codes 996.60 or 996.69 or a combination of diagnosis and procedure codes*; in the xenograft study arm, any downstream episode with ICD9 diagnosis codes 996.60 or 996.69 or a combination of diagnosis and procedure codes* if the episode occurred within 90 days following the index event (otherwise, the classification changes to infection); in the primary repair study arm, any downstream episode with ICD9 diagnosis codes 996.60 or 996.69 or a combination of diagnosis and procedure codes* occurring subsequent to a post-index implantation of mesh (otherwise, the classification changes to infection).
Using Biodesign during ventral or incisional hernia repair typically involves coding for the repair and the appropriate C-code (when care is provided to Medicare patients in the hospital outpatient setting) to describe the device.
another type of hernia repair at the same patient encounter, CPT code 49568 may be reported with modifier 59 or XS to bypass edits bundling CPT code 49568 into all hernia repair codes other than the incisional or ventral hernia repair codes.
Grade 3 includes potentially contaminated patients with a previous wound infection, stoma, or other procedure involving violation of the gastrointestinal tract performed concurrent with the ventral hernia repair , and grade 4 includes patients with infected mesh or septic dehiscence.
1. During an open abdominal procedure, exploration of the surgical field is routinely performed to identify anatomic structures and disease. An exploratory laparotomy (CPT code 49000) is not separately reportable with an open abdominal procedure.
The 2022 edition of ICD-10-CM Z48.815 became effective on October 1, 2021.
Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00 -Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways: