E46
BillableUnspecified protein-calorie malnutrition
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E46 an HCC code?
Yes. E46 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 E46
For E46to 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 E46 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E46 is the ICD-10-CM diagnosis code for unspecified protein-calorie malnutrition. A condition where the body lacks adequate protein and calories, resulting in severe malnutrition and weight loss. The specific cause or type is not documented. E46 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, E46 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.
Use this code only when the type of protein-calorie malnutrition (kwashiorkor, marasmus, or mixed) cannot be determined from documentation. Because E46 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 E46 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Unspecified protein-calorie malnutrition indicates that a patient has documented malnutrition from inadequate protein and calorie intake, but neither the severity (mild, moderate, or severe) nor the type (kwashiorkor vs. marasmus) has been specified. This code signals a documentation opportunity to obtain greater specificity from the provider, which improves clinical care and audit defensibility.
Documentation Requirements
- ✓Documentation should include the clinical basis for the malnutrition diagnosis, including body mass index, weight trends, laboratory markers (albumin, prealbumin), physical exam findings, and nutritional screening results.
- ✓The provider should be queried to specify severity (mild, moderate, or severe) and type to enable assignment of a more specific code.
- ✓The underlying cause and treatment plan should be documented.
Excludes 1 — Do NOT code together
- nutritional deficiency NOS (E63.9)
Commonly Confused Codes
- •E43 (Unspecified severe protein-calorie malnutrition) specifies severe but not the type.
- •E44.0 and E44.1 specify moderate and mild severity respectively.
- •E40-E42 specify both severity and type.
- •R64 (Cachexia) describes disease-related wasting and is not a malnutrition code.
- •R63.4 (Abnormal weight loss) is a symptom code.
- •Z68.x (Body mass index) codes should be added when applicable.