E40
BillableKwashiorkor
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E40 an HCC code?
Yes. E40 maps to Protein-Calorie Malnutrition under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for E40
For E40to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E40 during that encounter — not just copy-forwarded from a problem list.
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).
Under the older CMS-HCC V24 model, E40 maps to Protein-Calorie Malnutrition (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Kwashiorkor is distinguished from marasmus by the presence of edema despite severe protein deficiency. Because E40 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, 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 is distinguished from marasmus by the presence of edema despite severe protein deficiency
- •Common in developing countries; document the underlying cause (poverty, famine, inadequate diet) when available
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.