E88.A
BillableWasting disease (syndrome) due to underlying condition
HCC Category Mapping
V24HCC 21 — Protein-Calorie Malnutrition
0.545ESRDHCC 21 — Protein-Calorie Malnutrition
0.000What This Code Means
Severe weight loss and muscle wasting caused by an underlying medical condition, often seen in chronic illnesses or malignancy.
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. This code carries a high RAF weight reflecting the severity and poor prognosis associated with cachexia.
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
Code First
- underlying condition
Commonly Confused Codes
R64 — Cachexia: use when cachexia is documented WITHOUT a specified underlying causeE41 — Nutritional marasmus: severe malnutrition from caloric deficiency, different mechanismE43 — Unspecified severe protein-calorie malnutrition: malnutrition without the wasting syndrome contextR63.4 — Abnormal weight loss: symptom code for weight loss without wasting syndrome diagnosisE46 — Unspecified protein-calorie malnutrition: less specific nutritional deficiency
Code Hierarchy
└E88Other and unspecified metabolic disorders└E88.AWasting disease (syndrome) due to underlying condition
└E88.AWasting disease (syndrome) due to underlying condition