E40

HCC Category Mapping

What This Code Means

Severe malnutrition caused by inadequate protein intake, characterized by edema, skin changes, and organ damage.

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.

Commonly Confused Codes