ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 4: Endocrine, nutritional and metabolic diseasesE43

E43

Billable

Unspecified severe protein-calorie malnutrition

Chapter 4:Endocrine, nutritional and metabolic diseases

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

Code Description

ICD-10 E43 is a billable code used to indicate a diagnosis of unspecified severe protein-calorie malnutrition.

Key Diagnostic Point:

Unspecified severe protein-calorie malnutrition (E43) is a condition characterized by a significant deficiency in both protein and calorie intake, leading to a state of malnutrition that can severely impact an individual's health. This condition is often seen in populations with limited access to adequate nutrition, such as in cases of famine, chronic illness, or socioeconomic factors. Protein-energy malnutrition can manifest in various forms, including kwashiorkor and marasmus. Kwashiorkor is primarily associated with protein deficiency despite adequate caloric intake, leading to symptoms such as edema, irritability, and skin lesions. Marasmus, on the other hand, results from a severe deficiency in both protein and calories, leading to significant weight loss, muscle wasting, and a frail appearance. The diagnosis of unspecified severe protein-calorie malnutrition is typically made when specific causes of malnutrition cannot be identified, necessitating a comprehensive assessment of dietary intake, clinical symptoms, and underlying health conditions. This code is crucial for capturing the severity of malnutrition in patients, which can influence treatment plans and healthcare resource allocation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of malnutrition (kwashiorkor vs. marasmus)
  • Identifying underlying causes of malnutrition
  • Variability in clinical presentation among patients
  • Need for comprehensive dietary assessments

Audit Risk Factors

  • Insufficient documentation of dietary intake
  • Lack of clinical indicators supporting malnutrition diagnosis
  • Inconsistent coding practices among providers
  • Failure to document underlying health conditions contributing to malnutrition

Specialty Focus

Medical Specialties

Nutrition and Dietetics

Documentation Requirements

Detailed dietary assessments, patient history, and clinical evaluations.

Common Clinical Scenarios

Patients with chronic illnesses, elderly patients with poor appetite, and those in rehabilitation settings.

Billing Considerations

Ensure that all aspects of the patient's nutritional status are documented, including any interventions or dietary modifications.

Pediatrics

Documentation Requirements

Growth charts, developmental assessments, and family dietary history.

Common Clinical Scenarios

Children with failure to thrive, those from low-income families, and those with chronic health issues affecting nutrition.

Billing Considerations

Documenting the child's growth patterns and any interventions taken to address nutritional deficiencies.

Coding Guidelines

Inclusion Criteria

Use E43 When
  • According to ICD
  • 10 coding guidelines, E43 should be used when there is clear evidence of severe protein
  • calorie malnutrition without a more specific diagnosis
  • Coders should ensure that the documentation supports the diagnosis and that other potential causes of malnutrition are ruled out

Exclusion Criteria

Do NOT use E43 When
No specific exclusions found.

Related CPT Codes

97802CPT Code

Medical nutrition therapy, individual, face-to-face

Clinical Scenario

Used when a patient is referred for dietary management due to malnutrition.

Documentation Requirements

Document the patient's nutritional assessment and treatment plan.

Specialty Considerations

Nutrition specialists should ensure that all dietary interventions are clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malnutrition-related conditions, improving the ability to capture the severity and type of malnutrition. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malnutrition-related conditions, improving the ability to capture the severity and type of malnutrition. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of malnutrition-related conditions, improving the ability to capture the severity and type of malnutrition. This specificity aids in better patient management and resource allocation.

Resources

Clinical References

  • •
    World Health Organization - Malnutrition

Coding & Billing References

  • •
    World Health Organization - Malnutrition

Frequently Asked Questions

What is the difference between kwashiorkor and marasmus?

Kwashiorkor is primarily due to protein deficiency with adequate caloric intake, characterized by edema and skin changes, while marasmus results from severe deficiency in both protein and calories, leading to significant weight loss and muscle wasting.