What is ICD-10 code E64.0?

E64.0 is the ICD-10-CM diagnosis code for Sequelae of protein-calorie malnutrition. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E64.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E64.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E64.0 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E64.0 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for E64.0?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. E64.0 was a payment HCC under V24 (Protein-Calorie Malnutrition) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting E64.0?

Use this code only for the long-term consequences or complications of past protein-calorie malnutrition, not for active malnutrition currently occurring This is a sequelae code (E64.0), so it should be used when documenting residual effects from a previous malnutrition episode; ensure documentation clearly indicates the condition is a result of prior malnutrition Because E64.0 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

E64.0: Sequelae of protein-calorie malnutrition —

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupE64.0Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Other nutritional deficiencies (E50-E64)

E64.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Sequelae of protein-calorie malnutrition

This code describes the lasting health problems that result from severe malnutrition where a person didn't get enough protein and calories in the past. These lingering effects can include stunted growth, weakened muscles, or other complications that persist even after the malnutrition has been treated.

Buddy Insight

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Mapped

HCC 21

Protein-Calorie Malnutrition

RAF 0.545

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 21

Protein-Calorie Malnutrition

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

E64Sequelae of malnutrition and other nutritional deficiencies

E64.0Sequelae of protein-calorie malnutrition

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E64.0 in this effective period.

Excludes 2

Official

retarded development following protein-calorie malnutrition (E45)

Related Child Codes

Official

E64.1Sequelae of vitamin A deficiency

E64.2Sequelae of vitamin C deficiency

E64.3Sequelae of rickets

E64.8Sequelae of other nutritional deficiencies

E64.9Sequelae of unspecified nutritional deficiency

Includes

Official

ICD-10-CM does not list Includes notes for E64.0 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E64.0 in this effective period.

Code First

Official

condition resulting from (sequela) of malnutrition and other nutritional deficiencies

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E64.0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E64.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must clearly establish a causal relationship between prior protein-calorie malnutrition and the current residual conditions.

The provider should document the history of malnutrition including approximate timing and severity, the specific sequelae present (growth failure, organ damage, metabolic abnormalities), and current management needs.

Laboratory and imaging findings supporting ongoing deficits should be included.

MEAT Support

HCC Buddy guidance

Documentation must clearly establish a causal relationship between prior protein-calorie malnutrition and the current residual conditions.

Laboratory and imaging findings supporting ongoing deficits should be included.

Audit Caution

HCC Buddy guidance

Do not assign this sequela code concurrently with active malnutrition codes (E40-E46) for the same condition.

This code is for residual effects after malnutrition has been treated or resolved.

The provider must establish the causal link to prior malnutrition rather than attributing the sequelae to other causes.

Code the specific residual condition separately when possible in addition to this etiology code.

Common Mistakes

HCC Buddy guidance

E40-E46 (Active protein-calorie malnutrition codes) are used when malnutrition is currently active, not resolved with residual effects.

E45 (Retarded development following protein-calorie malnutrition) is specific to developmental delays.

R64 (Cachexia) describes wasting from chronic disease, not sequelae of prior malnutrition.

The specific sequela condition should also be coded when identifiable.

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 E64.0 an HCC code?

Yes. E64.0 maps to Protein-Calorie Malnutrition under the V24 model but is not retained in V28.

HCC Category Mapping

V24HCC 21, Protein-Calorie Malnutrition

0.545

ESRDHCC 21, Protein-Calorie Malnutrition

0.000

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 E64.0

For E64.0to 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 E64.0 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

E64.0 is the ICD-10-CM diagnosis code for sequelae of protein-calorie malnutrition. This code describes the lasting health problems that result from severe malnutrition where a person didn't get enough protein and calories in the past. These lingering effects can include stunted growth, weakened muscles, or other complications that persist even after the malnutrition has been treated. E64.0 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering other nutritional deficiencies (e50-e64).

Under the older CMS-HCC V24 model, E64.0 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 for the long-term consequences or complications of past protein-calorie malnutrition, not for active malnutrition currently occurring. Because E64.0 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 E64.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only for the long-term consequences or complications of past protein-calorie malnutrition, not for active malnutrition currently occurring
•This is a sequelae code (E64.0), so it should be used when documenting residual effects from a previous malnutrition episode; ensure documentation clearly indicates the condition is a result of prior malnutrition

Clinical Significance

Sequelae of protein-calorie malnutrition captures the lasting health consequences that persist after severe malnutrition has been treated, including stunted growth, chronic organ damage, impaired immune function, and metabolic derangements. These residual effects require ongoing medical monitoring and management even though the acute malnutrition has resolved, reflecting permanent or long-term physiological changes from the prior nutritional insult.

Documentation Requirements

✓Documentation must clearly establish a causal relationship between prior protein-calorie malnutrition and the current residual conditions.
✓The provider should document the history of malnutrition including approximate timing and severity, the specific sequelae present (growth failure, organ damage, metabolic abnormalities), and current management needs.
✓Laboratory and imaging findings supporting ongoing deficits should be included.

Excludes 2, Not included here, may code separately

retarded development following protein-calorie malnutrition (E45)

Commonly Confused Codes

•E40-E46 (Active protein-calorie malnutrition codes) are used when malnutrition is currently active, not resolved with residual effects.
•E45 (Retarded development following protein-calorie malnutrition) is specific to developmental delays.
•R64 (Cachexia) describes wasting from chronic disease, not sequelae of prior malnutrition.
•The specific sequela condition should also be coded when identifiable.