October 1 update. Our PDGM and ICD-10 tools now use the FY2027 code set: 190 codes added, 30 deleted, and no existing code changed clinical group.

See what changed

ICD-10 · PDGM grouping

K42 Umbilical hernia

All 3 codes in the K42 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Codes in family

3

Can lead a claim

3

Cannot lead a claim

0

What CMS assigns to K42

All 3 codes group to MMTA - Gastrointestinal tract and Genitourinary system. None of the 3 is assigned a comorbidity subgroup. Every code can lead a claim.

Every code in K42

Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.

CodeDescriptionPrimary positionClinical groupComorbidity subgroup
K42.0Umbilical hernia with obstruction, without gangreneCan lead a claimJNone
K42.1Umbilical hernia with gangreneCan lead a claimJNone
K42.9Umbilical hernia without obstruction or gangreneCan lead a claimJNone

Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.

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