Is ICD-10-CM code K42 billable?

No, K42 (Umbilical hernia) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code K42 belong to?

K42 belongs to Chapter 11 of the ICD-10-CM tabular list: K00–K95 (Diseases of the Digestive System).

K42Not billable, use a more specific code below

Umbilical hernia

In Hernia (K40-K46), chapter 11: Diseases of the Digestive System

3 billable codes under K42: 1 is an MCC, 1 is a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Includes: conditions that are coded here

paraumbilical hernia

Excludes1: not coded here, use a different code

omphalocele (Q79.2)

Also applies, from Hernia (K40-K46)

These notes sit on K40-K46 and apply to every code under it, including K42.

Includes: conditions that are coded here

acquired hernia
congenital [except diaphragmatic or hiatus] hernia
recurrent hernia

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

There are no chapter-specific rules for Chapter 11 yet, so the general rules in Section I.B apply.

Read Section I.C.11 (page 58)

All codes under K42

K42 can't be used on a claim. Pick a billable code below; grey headings group them.

K42 MS-DRGs

As the principal diagnosis, the billable codes under K42 group to MS-DRG 393, 394, 395, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 393 Other Digestive System Diagnoses with MCC (3 of 3 codes)
DRG 394 Other Digestive System Diagnoses with CC (3 of 3 codes)
DRG 395 Other Digestive System Diagnoses without CC/MCC (3 of 3 codes)
DRG 791 Prematurity with Major Problems (2 of 3 codes)
DRG 793 Full Term Neonate with Major Problems (2 of 3 codes)

Other codes that refer to K42

Notes on these codes point to K42.

Q79.2 Excludes1: umbilical hernia (K42.-)
Q79.5 Excludes1: umbilical hernia (K42.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Hernia

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen. There are several types of hernias, including:

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.