ICD-10 Coding for Severe Protein-Calorie Malnutrition(E43)
Complete ICD-10-CM coding and documentation guide for Severe 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 Severe Protein-Calorie Malnutrition
E40-E46Primary Range
Malnutrition
This range includes all forms of malnutrition, with E43 specifically for severe protein-calorie malnutrition.
Key Information: ICD-10 code for severe protein-calorie malnutrition
Essential facts and insights about Severe Protein-Calorie Malnutrition
Primary ICD-10-CM Code for severe protein-calorie malnutrition
Decision Criteria
clinical Criteria
- Patient exhibits severe weight loss and muscle wasting.
documentation Criteria
- Provider documents severity and treatment plan.
Applicable To
- Severe malnutrition
- Severe protein-energy malnutrition
Clinical Validation Requirements
- BMI <18.5
- >10% weight loss over 6 months
- Severe muscle mass loss
Code-Specific Risks
- Incorrectly coding without meeting severity criteria
- Relying solely on dietitian notes
Coding Notes
- Ensure documentation includes specific ASPEN/GLIM criteria and treatment plans.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Cachexia
R64Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Severe 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 patient assessment and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Use ASPEN/GLIM criteria for documentation., Ensure provider specifies severity in notes.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure documentation includes specific ASPEN/GLIM criteria.
Impact
High error rate in documenting severity of malnutrition.
Mitigation Strategy
Use structured templates and ensure provider documentation.
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 Severe Protein-Calorie Malnutrition, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Severe Protein-Calorie Malnutrition
Use these documentation templates to ensure complete and accurate documentation for Severe Protein-Calorie Malnutrition. These templates include all required elements for proper coding and billing.
Severe PCM in Oncology
Specialty: OncologyRequired Elements
- BMI and weight loss percentage
- Muscle mass loss
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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