Health Evidence Review Commission's Value-based Benefits Subcommittee

Diaphragmatic Hernia
Question: Where should obstructed or gangrenous diaphragmatic hernia be prioritized?
Question source: HERC staff
Issue: ICD-10 K44.0 (Diaphragmatic hernia with obstruction, without gangrene) and K44.1
(Diaphragmatic hernia with gangrene) were moved from line 172 COMPLICATED HERNIAS;
UNCOMPLICATED INGUINAL HERNIA IN CHILDREN AGE 18 AND UNDER; PERSISTENT
HYDROCELE to line 385 ESOPHAGITIS; ESOPHAGEAL AND INTRAESOPHAGEAL HERNIAS as an
errata in January 2016. Line 385 contains the CPT codes for diaphragmatic hernia repair that
need to pair with these diagnoses and the ICD-9 code equivalent for these diagnoses was on
line 385. This errata was done to allow pairing of these diagnoses with appropriate treatment.
Uncomplicated diaphragmatic hernia (K44.9 Diaphragmatic hernia without obstruction or
gangrene) is on line 516 ESOPHAGITIS AND GERD; ESOPHAGEAL SPASM; ASYMPTOMATIC
DIAPHRAGMATIC HERNIA, which is appropriate as the major issue with this diagnosis is GERD
type symptoms and complications.
The ICD-10 Gastroenterology reviewers had intentionally moved the diaphragmatic hernia
codes to the upper line as they felt that any obstructed or gangrenous hernia should be
prioritized together and relatively high on the Prioritized List.
Expert Input
Dr. Kimberly Ruscher, pediatric surgeon
If you need to pair the K44 codes with treatment, I would keep them under the
complicated hernia line…gangrenous or complicated hernias are just as dangerous as
other complicated hernias. The reason I say this is that whether the hernia is in the
diaphragm, the abdominal wall, inguinal region, or an internal hernia, if there is an
obstruction we have to treat it by treating the hernia, and if gangrene is present the
patient’s life will be threatened. Thus, I think that the most straightforward thing is to
pair gangrenous/obstructed diaphragmatic hernia and treatment on the line for
complicated hernias.