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E42 ICD-10-CM Code: Marasmic kwashiorkor

E42 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupE42

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

E42

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

Marasmic kwashiorkor

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

Buddy the Bee presenting code insight

Buddy Insight

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.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 023

Code-level coefficient reference

ESRD/PACE

HCC 21

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
E4Malnutrition (E40-E46)E42Marasmic kwashiorkor

Inclusion Terms

Official
  • Intermediate form severe protein-calorie malnutrition
  • Severe protein-calorie malnutrition with signs of both kwashiorkor and marasmus

Excludes 2

Official
  • nutritional anemias (D50-D53)Inherited from E40-E46
  • starvation (T73.0)Inherited from E40-E46

Related Codes

Official

No related codes are included in this display for E42. Check the Code Book for the complete code path.

Includes

Official

No Includes notes are included in this display for E42. Check the code and parent instructions in the Code Book.

Excludes 1

Official
  • 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

Official

No Code First sequencing instructions are included in this display for E42. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for E42. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for E42. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
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.

MEAT Support

HCC Buddy guidance
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.

Audit Caution

HCC Buddy guidance
Both severe wasting and edema must be documented by the provider to assign this code.
Do not assume marasmic kwashiorkor simply because a malnourished patient has edema, as other causes of edema must be ruled out.
This code represents the most severe malnutrition category and should only be assigned when documentation clearly supports both components.
Monitor for refeeding syndrome during treatment.

Common Mistakes

HCC Buddy guidance
E40 (Kwashiorkor) has edema but without the severe wasting component.
E41 (Nutritional marasmus) has severe wasting but without edema.
E43 (Unspecified severe protein-calorie malnutrition) is used when the type cannot be determined.
Do not confuse with anasarca from heart failure (I50.x) or nephrotic syndrome (N04.x) superimposed on cachexia.

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 E42 an HCC code?

E42 is not in the CMS-HCC V28 or V24 community payment model. E42 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E42 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
E42
Description
Marasmic kwashiorkor
HCC (V28)
No CMS-HCC V28 mapping
RAF reference coefficient
—
Billable
Yes
Payment year
2026

HCC Category Mapping

ESRDHCC 21, Protein-Calorie Malnutrition
Not separately weighted

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 E42 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E42

For E42, 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

E42 is the ICD-10-CM diagnosis code for marasmic kwashiorkor. A combination of both kwashiorkor and marasmus, representing the most severe form of protein-calorie malnutrition with both edema and severe wasting. E42 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering malnutrition (e40-e46).

E42 has no mapping under the CMS-HCC V28 or V24 community payment models. E42 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E42 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.

Marasmic kwashiorkor, mixed severe PCM with features of both marasmus and kwashiorkor.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Marasmic kwashiorkor, mixed severe PCM with features of both marasmus and kwashiorkor.
  • •A specific combined presentation requiring documentation of both wasting and edema/pigmentation features.
  • •Protein-calorie malnutrition is not risk-adjusted in V28; code it accurately for clinical completeness only.

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

  • •E40 (Kwashiorkor) has edema but without the severe wasting component.
  • •E41 (Nutritional marasmus) has severe wasting but without edema.
  • •E43 (Unspecified severe protein-calorie malnutrition) is used when the type cannot be determined.
  • •Do not confuse with anasarca from heart failure (I50.x) or nephrotic syndrome (N04.x) superimposed on cachexia.

Code Hierarchy

└E42Marasmic kwashiorkor
└E42Marasmic kwashiorkor

More on E42

Related condition guides

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