Is K42 a billable ICD-10-CM code?

No. K42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does K42 sit in the tabular list?

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

What cannot be coded together with K42?

K42 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

K42

K42 — Umbilical hernia

Non-billable headerICD-10-CM

K42 is a non-billable header ICD-10-CM code for umbilical hernia. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

omphalocele (Q79.2)

Includes

Conditions this code covers.

paraumbilical hernia

Other codes that can never be billed with K42

These codes carry an Excludes1 note pointing at K42. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading K42 alone.

Q79.2Exomphalos
Q79.5Other congenital malformations of abdominal wall
I96Gangrene, not elsewhere classified

Risk adjustment

K42 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.

Code to one of these instead K42

3 child codes. Green means billable.

Questions about K42

Is K42 a billable ICD-10-CM code?: No. K42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does K42 sit in the tabular list?: Diseases of the digestive system (K00-K95), in the block Hernia (K40-K46).
What cannot be coded together with K42?: K42 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.