Severe Malnutrition Diagnosis Codes Checklist

Severe Malnutrition Diagnosis Codes (Nutritional Marasmus E41 and Unspecified Severe Protein-Calorie Malnutrition E43) Checklist

Nutritional marasmus (diagnosis code E41) and unspecified severe protein-calorie malnutrition (diagnosis code E43) are two types of severe malnutrition listed in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

Nutritional marasmus is a form of serious protein-energy malnutrition that is caused by a deficiency in calories and energy and is found primarily in children. Previous Office of Inspector General (OIG) audits of severe malnutrition1 found that hospitals had incorrectly billed Medicare by using severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all. Diagnosis codes E41 and E43 (collectively referred to in this report as “severe malnutrition diagnosis codes”) are classified as a type of major complication or comorbidity (MCC). Adding MCCs to a Medicare claim can result in a higher Medicare payment.

This Malnutrition Documentation E41 and E43 Checklist (PDF) is intended to provide healthcare providers with a reference for use when responding to medical documentation requests for services rendered and hospital admissions to treat malnutrition. Providers retain responsibility to submit complete and accurate documentation.

Resource: IOM, Pub. 100-08, Chapter 6, Section 6.5.3 (PDF)