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    v1.0.28
    OpenPayerBilling CodesHerniaICD-10-CM k42-umbilical-hernia
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    ICD-10-CM Code For Umbilical Hernia: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group K42 includes diagnoses for umbilical hernias, covering congenital and acquired defects of the umbilical ring with or without incarceration or obstruction. These ICD-10-CM diagnosis codes are used to document clinical scenarios such as symptomatic protrusion at the umbilicus, complications like incarceration or obstruction, and status after hernia repair. Accurate coding within the ICD-10-CM K42 group supports appropriate claim adjudication and complete clinical documentation for reimbursement considerations.

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    ICD-10-CM K42: Umbilical Hernia Overview

    The ICD-10-CM K42 group covers diagnoses for umbilical hernias, which are protrusions of intra-abdominal contents through the umbilical ring. These codes target the abdominal wall and related surgical or clinical management of the hernia. Accurate coding matters for correct clinical documentation and reimbursement because it captures severity, complications, and any repair status that affect claim processing.

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    When to Use

    Use a code from this group when documenting a clinical encounter for an umbilical hernia, including when specifying incarceration, obstruction, or post-operative status. Select the code that reflects the current clinical state and any complicating features documented in the medical record.

    ICD-10-CM Codes

    3 rows

    ICD-10-CM CodeDescription
    K42.0Umbilical hernia with obstruction, without gangrene
    K42.1Umbilical hernia with gangrene
    K42.9Umbilical hernia without obstruction or gangrene

    DRG Codes

    5 rows

    DRG CodeDescription
    393Other Digestive System Diagnoses with MCC
    394Other Digestive System Diagnoses with CC
    395Other Digestive System Diagnoses without CC/MCC
    791Prematurity with Major Problems
    793Full Term Neonate with Major Problems

    Typical Clinical Scenarios

    • An adult patient presents to the emergency department with a painful, tender bulge at the umbilicus after a recent episode of coughing and vomiting. On exam the hernia is reducible but the patient reports increasing localized pain and skin erythema; manual reduction is successful and conservative management is planned. A diagnosis from this group is assigned for a reducible umbilical hernia without mention of chronicity or other complications. Typical codes: K42.9
    • A middle-aged patient with obesity and multiple prior pregnancies attends a primary care visit for evaluation of a long-standing, non-acute protrusion at the navel that has gradually enlarged over months and is asymptomatic except for cosmetic concern and mild discomfort with exertion. The clinician documents a chronic, uncomplicated umbilical hernia as the reason for follow-up and potential elective repair discussion. Typical codes: K42.1, K42.9
    • An infant is brought to pediatric surgery clinic with a persistent umbilical bulge noted since birth that remains present with crying and is reducible; the family seeks assessment for timing of repair due to intermittent episodes of incarceration concern. The encounter documents a congenital-type umbilical hernia requiring monitoring for complication risk. Typical codes: K42.0, K42.1

    Related Codes

    K40-INGUINAL-HERNIA

    ICD-10-CM Code For Inguinal Hernia: Group Overview

    K41-FEMORAL-HERNIA

    ICD-10-CM Code For Femoral Hernia: Group Overview

    K43-VENTRAL-HERNIA

    ICD-10-CM Code For Ventral Hernia: Group Overview

    K44-DIAPHRAGMATIC-HERNIA

    ICD-10-CM Code For Diaphragmatic Hernia: Group Overview

    K45-OTHER-ABDOMINAL-HERNIA

    ICD-10-CM Code For Other Abdominal Hernia: Group Overview

    K46-UNSPECIFIED-ABDOMINAL-HERNIA

    ICD-10-CM Code For Unspecified Abdominal Hernia: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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