E43

HCC Category Mapping

What This Code Means

Severe malnutrition due to inadequate protein and calories when the specific type (kwashiorkor vs. marasmus) cannot be determined.

Coding Tips

• •Use this code when documentation doesn't clearly distinguish between kwashiorkor and marasmus
• •This is a less specific code; try to obtain more clinical detail to assign a more specific E40-E42 code if possible

Clinical Significance

Unspecified severe protein-calorie malnutrition indicates that a patient has documented severe malnutrition but the clinical picture does not clearly distinguish between kwashiorkor and marasmus, or the provider has not specified the type. This still represents a life-threatening nutritional state requiring urgent medical intervention and careful refeeding to avoid refeeding syndrome.

Documentation Requirements

• ✓Documentation should include evidence of severe malnutrition such as body mass index below 16, severe muscle wasting, laboratory markers (albumin below 2.5 g/dL, prealbumin below 5 mg/dL), and functional impairment.
• ✓The provider should attempt to specify whether edema is present (suggesting kwashiorkor) or absent (suggesting marasmus) for more specific coding.
• ✓Underlying cause and treatment plan must be documented.

Commonly Confused Codes