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ICD-10 Guide
ICD-10 CodesChapter 4: Endocrine, nutritional and metabolic diseasesE42

E42

Billable

Marasmic kwashiorkor

Chapter 4:Endocrine, nutritional and metabolic diseases

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E42 is a billable code used to indicate a diagnosis of marasmic kwashiorkor.

Key Diagnostic Point:

Marasmic kwashiorkor is a severe form of protein-energy malnutrition characterized by a combination of marasmus and kwashiorkor. It typically occurs in children who are weaned from breast milk and do not receive adequate protein and caloric intake. The condition is marked by significant weight loss, muscle wasting, and edema. Children with marasmic kwashiorkor often present with a distended abdomen, skin changes, and hair discoloration. The underlying cause is usually a lack of sufficient dietary protein and calories, often exacerbated by infections or other health issues. This condition is prevalent in areas with food scarcity and can lead to severe complications, including immune dysfunction and increased mortality risk. Diagnosis is based on clinical assessment, nutritional history, and anthropometric measurements. Treatment involves nutritional rehabilitation, addressing any underlying infections, and providing supportive care to restore health and prevent long-term sequelae.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between marasmus and kwashiorkor can be challenging.
  • Requires comprehensive documentation of nutritional status and dietary intake.
  • Potential overlap with other malnutrition codes may lead to confusion.
  • Involves understanding of both clinical and dietary aspects for accurate coding.

Audit Risk Factors

  • Inadequate documentation of dietary intake and nutritional assessment.
  • Failure to document coexisting conditions that may contribute to malnutrition.
  • Misclassification of malnutrition type due to overlapping symptoms.
  • Lack of follow-up documentation on treatment response and outcomes.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed growth charts, dietary history, and clinical assessments.

Common Clinical Scenarios

Children presenting with failure to thrive, recurrent infections, or developmental delays.

Billing Considerations

Consideration of socioeconomic factors affecting nutrition and access to food.

Nutrition

Documentation Requirements

Comprehensive nutritional assessments and intervention plans.

Common Clinical Scenarios

Patients undergoing nutritional rehabilitation or those with chronic illnesses affecting intake.

Billing Considerations

Collaboration with other specialties to address underlying health issues.

Coding Guidelines

Inclusion Criteria

Use E42 When
  • According to ICD
  • 10 guidelines, E42 should be used when a patient presents with clinical features of both marasmus and kwashiorkor
  • Documentation must support the diagnosis, including evidence of weight loss, edema, and dietary deficiencies

Exclusion Criteria

Do NOT use E42 When
  • Exclusion criteria include other specified malnutrition types

Related CPT Codes

97802CPT Code

Medical nutrition therapy, individual, face-to-face, each 15 minutes

Clinical Scenario

Used for patients receiving nutritional counseling for malnutrition.

Documentation Requirements

Document the patient's nutritional status and treatment plan.

Specialty Considerations

Pediatric nutrition specialists may need to provide detailed growth and dietary assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malnutrition types, improving the accuracy of data collection and reimbursement processes. E42 provides a clear distinction between marasmic kwashiorkor and other forms of malnutrition, facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malnutrition types, improving the accuracy of data collection and reimbursement processes. E42 provides a clear distinction between marasmic kwashiorkor and other forms of malnutrition, facilitating better patient management.

Reimbursement & Billing Impact

reimbursement processes. E42 provides a clear distinction between marasmic kwashiorkor and other forms of malnutrition, facilitating better patient management.

Resources

Clinical References

  • •
    World Health Organization - Malnutrition

Coding & Billing References

  • •
    World Health Organization - Malnutrition

Frequently Asked Questions

What are the primary causes of marasmic kwashiorkor?

Marasmic kwashiorkor is primarily caused by a severe deficiency in both protein and caloric intake, often exacerbated by infections, socioeconomic factors, and inadequate dietary practices.

How can marasmic kwashiorkor be treated?

Treatment involves nutritional rehabilitation, which includes providing adequate protein and calories, addressing any underlying infections, and monitoring the patient's recovery closely.