Ventral hernia
In Hernia (K40-K46), chapter 11: Diseases of the Digestive System
9 billable codes under K43: 3 are an MCC, 3 are a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.
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Instructional notes
Also applies, from Hernia (K40-K46)
These notes sit on K40-K46 and apply to every code under it, including K43.
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.
All codes under K43
K43 can't be used on a claim. Pick a billable code below; grey headings group them.
- K43.0Incisional hernia with obstruction, without gangrene
- K43.1Incisional hernia with gangrene
- K43.2Incisional hernia without obstruction or gangrene
- K43.3Parastomal hernia with obstruction, without gangrene
- K43.4Parastomal hernia with gangrene
- K43.5Parastomal hernia without obstruction or gangrene
- K43.6Other and unspecified ventral hernia with obstruction, without gangrene
- K43.7Other and unspecified ventral hernia with gangrene
- K43.9Ventral hernia without obstruction or gangrene
K43 MS-DRGs
As the principal diagnosis, the billable codes under K43 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 (9 of 9 codes)
- DRG 394 Other Digestive System Diagnoses with CC (9 of 9 codes)
- DRG 395 Other Digestive System Diagnoses without CC/MCC (9 of 9 codes)
- DRG 791 Prematurity with Major Problems (6 of 9 codes)
- DRG 793 Full Term Neonate with Major Problems (6 of 9 codes)
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:
Read more about hernia on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.