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E41 ICD-10-CM Code: Nutritional marasmus

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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Malnutrition (E40-E46)

E41

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Nutritional marasmus

Severe malnutrition caused by inadequate calories and protein, resulting in extreme weight loss and muscle wasting without significant edema.

Buddy the Bee presenting code insight

Buddy Insight

Nutritional marasmus represents severe total calorie and protein deficiency resulting in extreme wasting of body fat and muscle mass, typically without significant edema.

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

HCC 21

RAF 0.455

ACA/HHS

HCC 23

Varies by metal level

ESRD/PACE

HCC 21

RAF 0.068

RXHCC

N/A

—

Not mapped

Code Book Path

Official
E4Malnutrition (E40-E46)
E41Nutritional marasmus

Inclusion Terms

Official
  • Severe malnutrition with marasmus

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E41 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under E41 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for E41 in this effective period.

Excludes 1

Official
  • marasmic kwashiorkor (E42)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E41 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E41 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E41 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documentation must describe severe wasting with loss of subcutaneous fat and muscle mass, body mass index or weight-for-height measurements, serum albumin and prealbumin levels, and the absence of significant peripheral edema (which would suggest kwashiorkor).
The underlying cause, nutritional assessment, and treatment plan including caloric goals should be documented.
Complications such as hypothermia, hypoglycemia, and infection should be noted.

MEAT Support

HCC Buddy guidance
Documentation must describe severe wasting with loss of subcutaneous fat and muscle mass, body mass index or weight-for-height measurements, serum albumin and prealbumin levels, and the absence of significant peripheral edema (which would suggest kwashiorkor).
The underlying cause, nutritional assessment, and treatment plan including caloric goals should be documented.
Complications such as hypothermia, hypoglycemia, and infection should be noted.

Audit Caution

HCC Buddy guidance
Do not confuse marasmus with cachexia (R64) caused by cancer or chronic inflammatory diseases, which has a different pathophysiology and treatment approach.
Ensure the provider documents this as a nutritional deficiency rather than disease-related wasting.
Do not upgrade mild or moderate malnutrition to marasmus without supporting clinical findings of severe wasting.
Refeeding syndrome is a critical complication that should be monitored and coded separately if it occurs.

Common Mistakes

HCC Buddy guidance
E40 (Kwashiorkor) has edema as the distinguishing feature.
E42 (Marasmic kwashiorkor) combines both wasting and edema.
E43 (Unspecified severe protein-calorie malnutrition) is used when the specific type cannot be determined.
E44.0 (Moderate protein-calorie malnutrition) indicates less severe involvement.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is E41 an HCC code?

Yes. E41 maps to Protein-Calorie Malnutrition under the V24 model but is not retained in V28.

HCC Category Mapping

V24HCC 21, Protein-Calorie Malnutrition
0.455
ESRDHCC 21, Protein-Calorie Malnutrition
0.068

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work E41 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E41

For E41to 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 E41 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E41 is the ICD-10-CM diagnosis code for nutritional marasmus. Severe malnutrition caused by inadequate calories and protein, resulting in extreme weight loss and muscle wasting without significant edema. E41 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, E41 maps to Protein-Calorie Malnutrition (HCC 21) with a community, non-dual, aged base RAF weight of 0.455. 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.

Marasmus presents with severe wasting but typically without edema, distinguishing it from kwashiorkor. Because E41 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 E41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Marasmus presents with severe wasting but typically without edema, distinguishing it from kwashiorkor
  • •Often seen in infants and young children in resource-limited settings

Clinical Significance

Nutritional marasmus represents severe total calorie and protein deficiency resulting in extreme wasting of body fat and muscle mass, typically without significant edema. Patients present with emaciated appearance, loss of subcutaneous fat, muscle atrophy, and a characteristic aged or wizened facial appearance. This condition is life-threatening and carries high mortality without appropriate nutritional rehabilitation.

Documentation Requirements

  • ✓Documentation must describe severe wasting with loss of subcutaneous fat and muscle mass, body mass index or weight-for-height measurements, serum albumin and prealbumin levels, and the absence of significant peripheral edema (which would suggest kwashiorkor).
  • ✓The underlying cause, nutritional assessment, and treatment plan including caloric goals should be documented.
  • ✓Complications such as hypothermia, hypoglycemia, and infection should be noted.

Excludes 1, Do NOT code together

  • marasmic kwashiorkor (E42)

Commonly Confused Codes

  • •E40 (Kwashiorkor) has edema as the distinguishing feature.
  • •E42 (Marasmic kwashiorkor) combines both wasting and edema.
  • •E43 (Unspecified severe protein-calorie malnutrition) is used when the specific type cannot be determined.
  • •E44.0 (Moderate protein-calorie malnutrition) indicates less severe involvement.
  • •R64 (Cachexia) describes wasting from chronic disease but is not the same as nutritional marasmus.

Code Hierarchy

└E41Nutritional marasmus
└E41Nutritional marasmus

Because E41 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

More on E41

Related condition guides

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