E45 ICD-10-CM Code: Retarded development following protein-calorie malnutrition
E45 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Malnutrition (E40-E46)
E45
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceRetarded development following protein-calorie malnutrition
Delayed physical and mental development in children who have recovered from severe protein-calorie malnutrition.
Buddy Insight
Retarded development following protein-calorie malnutrition captures the lasting developmental consequences of severe early-life nutritional deprivation.
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- Nutritional short stature
- Nutritional stunting
- Physical retardation due to malnutrition
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 E45. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for E45. 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 E45. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E45. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E45. 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 E45 an HCC code?
E45 is not in the CMS-HCC V28 or V24 community payment model. E45 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E45 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
- E45
- Description
- Retarded development following 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 E45 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E45
For E45, 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
E45 is the ICD-10-CM diagnosis code for retarded development following protein-calorie malnutrition. Delayed physical and mental development in children who have recovered from severe protein-calorie malnutrition. E45 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering malnutrition (e40-e46).
E45 has no mapping under the CMS-HCC V28 or V24 community payment models. E45 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E45 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.
Retarded development following protein-calorie malnutrition, developmental delay attributed to prior malnutrition. Predominantly pediatric.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E45 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Retarded development following protein-calorie malnutrition, developmental delay attributed to prior malnutrition. Predominantly pediatric.
- •Rarely used in Medicare populations. More common in pediatric and international-health settings.
- •Protein-calorie malnutrition is not risk-adjusted in V28; code it accurately for clinical completeness only.
Clinical Significance
Retarded development following protein-calorie malnutrition captures the lasting developmental consequences of severe early-life nutritional deprivation. This includes stunted physical growth, delayed cognitive development, and impaired neurological function that persist even after nutritional rehabilitation. These sequelae reflect permanent or long-term damage from malnutrition during critical developmental windows.
Documentation Requirements
- ✓Documentation must establish a causal link between prior protein-calorie malnutrition and current developmental delays.
- ✓The provider should document the history of severe malnutrition, the age at which it occurred, current developmental status with specific deficits identified, and any developmental assessments or testing performed.
- ✓Growth charts showing persistent stunting and neurodevelopmental evaluations support this diagnosis.
Commonly Confused Codes
- •E64.0 (Sequelae of protein-calorie malnutrition) covers other long-term consequences beyond developmental delay.
- •E40-E46 (Active malnutrition codes) are for current nutritional deficiency.
- •F88 (Other disorders of psychological development) and F89 (Unspecified disorder of psychological development) may be confused but do not specify nutritional etiology.
- •R62.x (Lack of expected normal physiological development) is less specific.