E43 ICD-10-CM Code: Unspecified severe protein-calorie malnutrition
E43 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Malnutrition (E40-E46)
E43
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified severe protein-calorie malnutrition
Severe malnutrition due to inadequate protein and calories when the specific type (kwashiorkor vs. marasmus) cannot be determined.
Buddy Insight
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.
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- Starvation edema
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 E43. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for E43. 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
OfficialNo Code First sequencing instructions are included in this display for E43. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E43. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E43. 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 E43 an HCC code?
E43 is not in the CMS-HCC V28 or V24 community payment model. E43 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E43 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
- E43
- Description
- Unspecified severe protein-calorie malnutrition
- 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 E43 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E43
For E43, 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
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
E43 is the ICD-10-CM diagnosis code for unspecified severe protein-calorie malnutrition. Severe malnutrition due to inadequate protein and calories when the specific type (kwashiorkor vs. marasmus) cannot be determined. E43 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering malnutrition (e40-e46).
E43 has no mapping under the CMS-HCC V28 or V24 community payment models. E43 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E43 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.
Unspecified severe protein-calorie malnutrition, severe PCM without specification of marasmus vs kwashiorkor. Often used in hospitalized older adults with significant unintentional weight loss.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Unspecified severe protein-calorie malnutrition, severe PCM without specification of marasmus vs kwashiorkor. Often used in hospitalized older adults with significant unintentional weight loss.
- •Severe malnutrition requires documented clinical criteria, ASPEN/AND criteria, albumin, prealbumin, weight loss percentage, and muscle/fat wasting assessment. A bare weight-loss note is not sufficient.
- •Accurate PCM documentation still matters for clinical and quality purposes, but it no longer captures a risk-adjustment coefficient.
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
- •E40 (Kwashiorkor), E41 (Nutritional marasmus), and E42 (Marasmic kwashiorkor) are preferred when the type can be determined.
- •E44.0 (Moderate protein-calorie malnutrition) and E44.1 (Mild protein-calorie malnutrition) indicate less severe forms.
- •E46 (Unspecified protein-calorie malnutrition) does not specify severity.
- •Query the provider to determine if E40-E42 can be assigned instead.