E46 ICD-10-CM Code: Unspecified protein-calorie malnutrition
E46 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Malnutrition (E40-E46)
E46
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified 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.
Buddy Insight
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.
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- Malnutrition NOS
- Protein-calorie imbalance NOS
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 E46. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for E46. Check the code and parent instructions in the Code Book.
Excludes 1
Official- nutritional deficiency NOS (E63.9)
- 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 E46. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E46. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E46. 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 E46 an HCC code?
E46 is not in the CMS-HCC V28 or V24 community payment model. E46 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E46 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
- E46
- Description
- Unspecified 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 E46 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E46
For E46, 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
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).
E46 has no mapping under the CMS-HCC V28 or V24 community payment models. E46 has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E46 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 protein-calorie malnutrition, PCM without severity detail. Query the provider to move to E43, E44.0, or E44.1.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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
- •Unspecified protein-calorie malnutrition, PCM without severity detail. Query the provider to move to E43, E44.0, or E44.1.
- •Severity is almost always documentable with a nutritional assessment, unspecified PCM is a query target.
- •Protein-calorie malnutrition is not risk-adjusted in V28; code it accurately for clinical completeness only.
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.