E41 ICD-10-CM Code: Nutritional marasmus
E41 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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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 guidanceNutritional marasmus
Severe malnutrition caused by inadequate calories and protein, resulting in extreme weight loss and muscle wasting without significant edema.
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
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 marasmus
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 E41. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for E41. 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 E41. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E41. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E41. 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 E41 an HCC code?
E41 has no mapping under the current CMS-HCC V28 community payment model. E41 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E41 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
- E41
- Description
- Nutritional marasmus
- 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 E41 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E41
For E41, 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
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).
E41 has no mapping under the current CMS-HCC V28 community payment model. E41 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E41 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.
Nutritional marasmus, severe PCM with wasting but without the edematous features of kwashiorkor.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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
- •Nutritional marasmus, severe PCM with wasting but without the edematous features of kwashiorkor.
- •Marasmus is specifically wasting-predominant; documentation should support the clinical picture of muscle and fat wasting without edema.
- •Protein-calorie malnutrition is not risk-adjusted in V28; code it accurately for clinical completeness only.
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.