ICD-10 Coding for Protein-Calorie Malnutrition(E43, E41, E44.0, E44.1, E46)
Complete ICD-10-CM coding and documentation guide for Protein-Calorie Malnutrition. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Protein-Calorie Malnutrition
E40-E46Primary Range
Malnutrition
This range includes all forms of malnutrition, including protein-calorie malnutrition, which is critical for accurate diagnosis and coding.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E43 | Unspecified severe protein-calorie malnutrition | Use when severe malnutrition is documented without specific type. |
|
| E41 | Nutritional marasmus | Use when marasmus is specifically documented. |
|
| E44.0 | Moderate protein-calorie malnutrition | Use when moderate malnutrition is documented with specific criteria. |
|
| E44.1 | Mild protein-calorie malnutrition | Use when mild malnutrition is documented. |
|
| E46 | Unspecified protein-calorie malnutrition | Use when malnutrition is documented without severity. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for severe protein-calorie malnutrition
Essential facts and insights about Protein-Calorie Malnutrition
Primary ICD-10-CM Codes for protein-calorie malnutrition
Decision Criteria
clinical Criteria
- Severe weight loss and low BMI
Applicable To
- Severe PCM without further specification
Excludes
- Nutritional marasmus (E41)
Clinical Validation Requirements
- Weight loss >5% in 1 month
- BMI <18.5
- Prealbumin <15 mg/dL
Code-Specific Risks
- Overuse without meeting clinical criteria
- Audit risk due to high reimbursement impact
Coding Notes
- Ensure documentation specifies severity and meets ASPEN criteria.
E41 - Nutritional marasmus
Use when marasmus is specifically documented.
Applicable To
- Severe PCM with muscle and fat loss
Excludes
- Kwashiorkor (E42)
Clinical Validation Requirements
- Severe muscle wasting
- Absence of edema
- BMI <16
Coding Notes
Marasmus requires documentation of muscle and fat wasting.
E44.0 - Moderate protein-calorie malnutrition
Use when moderate malnutrition is documented with specific criteria.
Applicable To
- Moderate PCM with documented weight loss
Clinical Validation Requirements
- Weight loss 5-9% in 3 months
- Mild muscle loss
Coding Notes
Ensure weight loss and intake are documented.
E44.1 - Mild protein-calorie malnutrition
Use when mild malnutrition is documented.
Applicable To
- Mild PCM with minimal weight loss
Clinical Validation Requirements
- Weight loss 2-5% in 3 months
- Normal muscle mass
Coding Notes
Documentation must specify mild severity.
E46 - Unspecified protein-calorie malnutrition
Use when malnutrition is documented without severity.
Applicable To
- Generic malnutrition without severity
Clinical Validation Requirements
- Lack of specific severity documentation
Coding Notes
Encourage specificity in documentation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Sequelae of malnutrition
E64Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Protein-Calorie Malnutrition to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E43.
Impact
Clinical: Inaccurate clinical picture, Regulatory: Potential audit trigger, Financial: Underpayment risk
Mitigation Strategy
Ensure severity is documented, Use specific codes when criteria are met
Impact
Reimbursement: May lead to overpayment and audit risk., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation meets ASPEN criteria for severe malnutrition.
Impact
Reimbursement: Potential underpayment due to non-specific coding., Compliance: Fails to meet documentation standards., Data Quality: Lack of detail in patient records.
Mitigation Strategy
Specify severity level in documentation.
Impact
High risk of audits due to reimbursement impact.
Mitigation Strategy
Ensure documentation meets ASPEN criteria.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Protein-Calorie Malnutrition, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Protein-Calorie Malnutrition
Use these documentation templates to ensure complete and accurate documentation for Protein-Calorie Malnutrition. These templates include all required elements for proper coding and billing.
Inpatient malnutrition assessment
Specialty: Internal MedicineRequired Elements
- Weight loss percentage
- Nutritional intake
- Physical examination findings
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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