Is K43.6 a billable ICD-10-CM code?

Yes. K43.6 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does K43.6 sit in the tabular list?

Diseases of the digestive system (K00-K95), in the block Hernia (K40-K46).

K43.6

K43.6 — Other and unspecified ventral hernia with obstruction, without gangrene

Billable / specific codeICD-10-CM

K43.6 is a billable, specific ICD-10-CM code for other and unspecified ventral hernia with obstruction, without gangrene. It is valid for submission on a claim.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Epigastric hernia causing obstruction, without gangrene
Hypogastric hernia causing obstruction, without gangrene
Incarcerated epigastric hernia without gangrene
Incarcerated hypogastric hernia without gangrene
Incarcerated midline hernia without gangrene
Incarcerated spigelian hernia without gangrene
Incarcerated subxiphoid hernia without gangrene
Irreducible epigastric hernia without gangrene
Irreducible hypogastric hernia without gangrene
Irreducible midline hernia without gangrene
Irreducible spigelian hernia without gangrene
Irreducible subxiphoid hernia without gangrene
Midline hernia causing obstruction, without gangrene
Spigelian hernia causing obstruction, without gangrene
Strangulated epigastric hernia without gangrene
Strangulated hypogastric hernia without gangrene
Strangulated midline hernia without gangrene
Strangulated spigelian hernia without gangrene
Strangulated subxiphoid hernia without gangrene
Subxiphoid hernia causing obstruction, without gangrene

Risk adjustment

K43.6 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

K43.6 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56421Billing and Coding: CT of the Abdomen and Pelvis
A56658Billing and Coding: Cosmetic and Reconstructive Surgery

How K43.6 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to K43.6.

Hernia, hernial›ventral›with›obstruction
Hernia, hernial›ventral›specified NEC›with›obstruction

Related codes at this level

Codes that share K43. If K43.6 is not quite right, the correct code is usually one of these.

Questions about K43.6

Is K43.6 a billable ICD-10-CM code?: Yes. K43.6 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does K43.6 sit in the tabular list?: Diseases of the digestive system (K00-K95), in the block Hernia (K40-K46).