E45 ICD-10-CM Code: Retarded development following protein-calorie malnutrition
HCC Buddy Code Card
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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
00
RAF 0
CMS-HCC V24
MappedHCC 21
RAF 0.545
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 21
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Nutritional short stature
- Nutritional stunting
- Physical retardation due to malnutrition
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E45 in this effective period.
Related Child Codes
ICD-10-CM does not list child codes under E45 for this display context.
Includes
OfficialICD-10-CM does not list Includes notes for E45 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E45 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E45 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E45 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E45 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is E45 an HCC code?
Yes. E45 maps to Protein-Calorie Malnutrition under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for E45
For E45to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E45 during that encounter, not just copy-forwarded from a problem list.
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).
Under the older CMS-HCC V24 model, E45 maps to Protein-Calorie Malnutrition (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code indicates past malnutrition with ongoing developmental consequences; document the history of severe malnutrition. Because E45 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, 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
- •This code indicates past malnutrition with ongoing developmental consequences; document the history of severe malnutrition
- •Often used in pediatric cases where malnutrition occurred during critical developmental periods
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.