E42

HCC Category Mapping

What This Code Means

A combination of both kwashiorkor and marasmus, representing the most severe form of protein-calorie malnutrition with both edema and severe wasting.

Coding Tips

• •This code indicates the patient has features of both conditions simultaneously
• •Document the clinical presentation clearly to justify the marasmic kwashiorkor diagnosis

Clinical Significance

Marasmic kwashiorkor represents the most severe overlap form of protein-calorie malnutrition, combining the severe muscle and fat wasting of marasmus with the edema and hypoalbuminemia of kwashiorkor. This dual presentation indicates extreme nutritional depletion and carries the highest mortality risk among malnutrition syndromes, requiring immediate and carefully managed nutritional intervention.

Documentation Requirements

• ✓Documentation must describe both severe wasting (loss of subcutaneous fat and muscle) and bilateral pitting edema occurring simultaneously.
• ✓Laboratory values including serum albumin, prealbumin, transferrin, and electrolytes are required.
• ✓The provider should document the underlying cause, comprehensive nutritional assessment, and a detailed refeeding plan.
• ✓Complications including infection, electrolyte abnormalities, and organ dysfunction must be recorded.

Commonly Confused Codes