E88.A is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupE88.A

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)

E88.A

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

Wasting disease (syndrome) due to underlying condition

Severe weight loss and muscle wasting caused by an underlying medical condition, often seen in chronic illnesses or malignancy.

Buddy Insight

Wasting disease (cachexia) due to an underlying condition represents severe, progressive loss of muscle mass and weight that cannot be fully reversed by nutritional supplementation.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 023

HHS-HCC 023 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 21

Protein-Calorie Malnutrition

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

E88Other and unspecified metabolic disorders E88.AWasting disease (syndrome) due to underlying condition

Inclusion Terms

Official

Cachexia due to underlying condition

Excludes 2

Official

failure to thrive (R62.51, R62.7)
Ehlers-Danlos syndromes (Q79.6-)Inherited from E70-E88

Related Codes

Official

E88.0Disorders of plasma-protein metabolism, not elsewhere classified E88.1Lipodystrophy, not elsewhere classified E88.2Lipomatosis, not elsewhere classified E88.3Tumor lysis syndrome E88.4Mitochondrial metabolism disorders

Includes

Official

No Includes notes are included in this display for E88.A. Check the code and parent instructions in the Code Book.

Excludes 1

Official

cachexia NOS (R64)
nutritional marasmus (E41)
transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E70-E88, E88
androgen insensitivity syndrome (E34.5-)Inherited from E00-E89, E70-E88, E88
congenital adrenal hyperplasia (E25.0)Inherited from E00-E89, E70-E88, E88
hemolytic anemias attributable to enzyme disorders (D55.-)Inherited from E00-E89, E70-E88, E88
Marfan syndrome (Q87.4-)Inherited from E00-E89, E70-E88, E88
5-alpha-reductase deficiency (E29.1)Inherited from E00-E89, E70-E88, E88
histiocytosis X (chronic) (C96.6)Inherited from E00-E89, E70-E88, E88

Code First

Official

underlying condition

Use Additional

Official

codes for associated conditionsInherited from E88

Code Also

Official

No Code Also instructions are included in this display for E88.A. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Diagnosis of wasting disease, wasting syndrome, or cachexia by the provider

Identification of the underlying condition causing the wasting

Objective evidence: significant weight loss (typically >5% in 6 months), BMI, muscle mass assessment

Distinction from simple malnutrition or voluntary weight loss

MEAT Support

HCC Buddy guidance

Diagnosis of wasting disease, wasting syndrome, or cachexia by the provider

Identification of the underlying condition causing the wasting

Objective evidence: significant weight loss (typically >5% in 6 months), BMI, muscle mass assessment

Distinction from simple malnutrition or voluntary weight loss

Audit Caution

HCC Buddy guidance

Using R64 (cachexia) instead of E88.A when an underlying cause is documented

Confusing wasting/cachexia with simple malnutrition — cachexia involves metabolic changes beyond poor intake

Not coding the underlying cause of the wasting separately

Failing to differentiate between involuntary weight loss (R63.4) and true wasting syndrome

Common Mistakes

HCC Buddy guidance

R64 — Cachexia: use when cachexia is documented WITHOUT a specified underlying cause

E41 — Nutritional marasmus: severe malnutrition from caloric deficiency, different mechanism

E43 — Unspecified severe protein-calorie malnutrition: malnutrition without the wasting syndrome context

R63.4 — Abnormal weight loss: symptom code for weight loss without wasting syndrome diagnosis

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 E88.A an HCC code?

E88.A has no mapping under the current CMS-HCC V28 community payment model. E88.A has a separate mapping under the CMS-HCC ESRD model (HCC 21 (Protein-Calorie Malnutrition)); the applicable result needs member context. E88.A 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: E88.A
Description: Wasting disease (syndrome) due to underlying condition
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

ESRDHCC 21, Protein-Calorie Malnutrition

Not separately weighted

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 E88.A in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E88.A

For E88.A, 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

E88.A is the ICD-10-CM diagnosis code for wasting disease (syndrome) due to underlying condition. Severe weight loss and muscle wasting caused by an underlying medical condition, often seen in chronic illnesses or malignancy. E88.A sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

This code requires documentation of an underlying condition causing the wasting; code the primary condition as well.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E88.A sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code requires documentation of an underlying condition causing the wasting; code the primary condition as well
•Do not use this code for simple malnutrition or cachexia without an identified underlying cause

Clinical Significance

Wasting disease (cachexia) due to an underlying condition represents severe, progressive loss of muscle mass and weight that cannot be fully reversed by nutritional supplementation. It is commonly seen in advanced cancer, heart failure, COPD, HIV, and chronic kidney disease.

Documentation Requirements

✓Diagnosis of wasting disease, wasting syndrome, or cachexia by the provider
✓Identification of the underlying condition causing the wasting
✓Objective evidence: significant weight loss (typically >5% in 6 months), BMI, muscle mass assessment
✓Distinction from simple malnutrition or voluntary weight loss
✓Nutritional assessment and support plan
✓Documentation that wasting is NOT adequately explained by decreased caloric intake alone

Excludes 1, Do NOT code together

cachexia NOS (R64)
nutritional marasmus (E41)

Excludes 2, Not included here, may code separately

failure to thrive (R62.51, R62.7)

Code First

underlying condition

Commonly Confused Codes

•R64: Cachexia: use when cachexia is documented WITHOUT a specified underlying cause
•E41: Nutritional marasmus: severe malnutrition from caloric deficiency, different mechanism
•E43: Unspecified severe protein-calorie malnutrition: malnutrition without the wasting syndrome context
•R63.4: Abnormal weight loss: symptom code for weight loss without wasting syndrome diagnosis
•E46: Unspecified protein-calorie malnutrition: less specific nutritional deficiency