E40 ICD-10-CM Code: Kwashiorkor
E40 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Malnutrition (E40-E46)
E40
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceKwashiorkor
Severe malnutrition caused by inadequate protein intake, characterized by edema, skin changes, and organ damage.
Buddy Insight
Kwashiorkor is a severe form of protein malnutrition characterized by peripheral edema despite low albumin levels, skin and hair changes (depigmentation, flaky paint dermatosis), hepatomegaly with fatty liver, and immune dysfunction.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 023
Code-level coefficient reference
ESRD/PACE
MappedHCC 21
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Severe malnutrition with nutritional edema with dyspigmentation of skin and hair
Excludes 2
Official- nutritional anemias (D50-D53)Inherited from E40-E46
- starvation (T73.0)Inherited from E40-E46
Related Codes
No related codes are included in this display for E40. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for E40. Check the code and parent instructions in the Code Book.
Excludes 1
Official- marasmic kwashiorkor (E42)
- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E40-E46
- intestinal malabsorption (K90.-)Inherited from E00-E89, E40-E46
- sequelae of protein-calorie malnutrition (E64.0)Inherited from E00-E89, E40-E46
Code First
OfficialNo Code First sequencing instructions are included in this display for E40. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E40. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E40. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is E40 an HCC code?
E40 has no mapping under the current CMS-HCC V28 community payment model. E40 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E40 also appears in the HHS-HCC commercial risk model (HCC 023 (HHS-HCC 023 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping.
- Code
- E40
- Description
- Kwashiorkor
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work E40 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E40
For E40, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
E40 is the ICD-10-CM diagnosis code for kwashiorkor. Severe malnutrition caused by inadequate protein intake, characterized by edema, skin changes, and organ damage. E40 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering malnutrition (e40-e46).
E40 has no mapping under the current CMS-HCC V28 community payment model. E40 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E40 also appears in the HHS-HCC commercial risk model (HCC 023 (HHS-HCC 023 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
Kwashiorkor, protein-deficient malnutrition with edema and disturbance of pigmentation of skin and hair. Rare in the US but seen in specific populations.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Kwashiorkor, protein-deficient malnutrition with edema and disturbance of pigmentation of skin and hair. Rare in the US but seen in specific populations.
- •Do not default to kwashiorkor for general malnutrition, it is a specific clinical entity. Use E43 for severe unspecified PCM.
- •Protein-calorie malnutrition is not risk-adjusted in V28; code it accurately for clinical completeness only.
Clinical Significance
Kwashiorkor is a severe form of protein malnutrition characterized by peripheral edema despite low albumin levels, skin and hair changes (depigmentation, flaky paint dermatosis), hepatomegaly with fatty liver, and immune dysfunction. It is distinguished from marasmus by the presence of edema and relative preservation of body fat. In developed countries, it may be seen in elderly patients, those with chronic illness, or in cases of neglect.
Documentation Requirements
- ✓Documentation must include clinical findings supporting the diagnosis: bilateral pitting edema, serum albumin and prealbumin levels, skin and hair changes, hepatomegaly, and nutritional assessment.
- ✓Body mass index, weight history, and dietary intake should be recorded.
- ✓The provider should document the underlying cause (chronic illness, inadequate intake, malabsorption, neglect) and any complications such as infection or electrolyte imbalance.
Excludes 1, Do NOT code together
- marasmic kwashiorkor (E42)
Commonly Confused Codes
- •E41 (Nutritional marasmus) presents with severe wasting without edema.
- •E42 (Marasmic kwashiorkor) combines features of both conditions.
- •E43 (Unspecified severe protein-calorie malnutrition) is used when the specific type cannot be determined.
- •E44.0 (Moderate protein-calorie malnutrition) represents a less severe degree.
- •T73.0 (Starvation) may be appropriate in certain contexts.