Q&A: SOB and incarcerated ventral hernias

Q: A patient recently came in with shortness of breath (SOB) and was found to have a incarcerated ventral hernia. SOB was documented throughout the record. Can SOB be coded separately or is it integral to hernia?

A: An incarcerated ventral hernia occurs when the intestine becomes trapped in the weak abdominal wall and can’t be pushed back inside the abdominal cavity. This may cause a blockage or cut off the blood supply to the intestine.

When you look up “incarcerated ventral hernia” in the Alphabetic Index, under the main bolded term, you’ll see the term incarcerated that directs you to see hernia, by site, with obstruction. So, when you look up “ventral” you find:

Ventral K43.9

with

gangrene (and obstruction) K43.7

obstruction K43.6

You then have to turn to the Tabular List and look for code K43.6, Other and unspecified ventral hernia with obstruction, without gangrene.

CDI professionals need to become familiar with the process of looking up diseases in the Alphabetic Index and following the directions, always verifying the code assignment in the Tabular List

As to your question regarding the coding of a condition that is, or is not, integral to another condition, there is no source that lists every condition as integral or not. If you’re unsure, have a conversation with, or send a query to, the physician, and speak with the coding staff and get their opinion. Also, review Official Guidelines for Coding and Reporting, section I.B.5 and section I.B.6, which states:

• Conditions that are an integral part of a disease process: Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
• Conditions that are not an integral part of a disease process: Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.

Editor’s Note: Sharme Brodie, RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps, click here.