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ICD-10 Guide
ICD-10 CodesChapter 4: Endocrine, nutritional and metabolic diseasesE46

E46

Billable

Unspecified protein-calorie malnutrition

Chapter 4:Endocrine, nutritional and metabolic diseases

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

Code Description

ICD-10 E46 is a billable code used to indicate a diagnosis of unspecified protein-calorie malnutrition.

Key Diagnostic Point:

Unspecified protein-calorie malnutrition (E46) refers to a condition characterized by inadequate intake of protein and calories, leading to a state of malnutrition. This condition can arise from various factors, including insufficient dietary intake, malabsorption syndromes, chronic illnesses, or increased metabolic demands. Patients may present with weight loss, muscle wasting, and a weakened immune response. The lack of specific classification under this code indicates that the malnutrition is not clearly defined as either kwashiorkor or marasmus, which are two distinct forms of protein-energy malnutrition. Kwashiorkor is typically associated with adequate caloric intake but insufficient protein, leading to edema and liver enlargement, while marasmus is characterized by severe caloric deficiency, resulting in significant weight loss and muscle wasting. The diagnosis of unspecified protein-calorie malnutrition often requires careful clinical assessment and may necessitate further investigation to identify underlying causes and appropriate nutritional interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and underlying causes
  • Need for comprehensive patient history and dietary assessment
  • Differentiation from other forms of malnutrition (kwashiorkor, marasmus)
  • Potential overlap with other diagnoses (e.g., chronic illness)

Audit Risk Factors

  • Inadequate documentation of dietary intake and nutritional assessment
  • Failure to specify the type of malnutrition when applicable
  • Lack of clinical correlation between symptoms and diagnosis
  • Insufficient follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Nutrition and Dietetics

Documentation Requirements

Detailed dietary assessments, patient history, and treatment plans.

Common Clinical Scenarios

Patients with chronic illnesses requiring nutritional support, elderly patients with weight loss.

Billing Considerations

Ensure that all dietary interventions and patient responses are documented to support the diagnosis.

Gastroenterology

Documentation Requirements

Clinical evaluations, diagnostic tests for malabsorption, and treatment plans.

Common Clinical Scenarios

Patients with gastrointestinal disorders leading to malnutrition.

Billing Considerations

Document any underlying gastrointestinal conditions that may contribute to malnutrition.

Coding Guidelines

Inclusion Criteria

Use E46 When
  • According to ICD
  • 10 coding guidelines, E46 should be used when the specific type of protein
  • calorie malnutrition is not documented
  • Coders should ensure that the diagnosis is supported by clinical findings and that other potential causes of malnutrition are ruled out

Exclusion Criteria

Do NOT use E46 When
No specific exclusions found.

Related CPT Codes

97802CPT Code

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

Clinical Scenario

Used for patients diagnosed with unspecified protein-calorie malnutrition requiring dietary counseling.

Documentation Requirements

Document the patient's nutritional assessment and treatment plan.

Specialty Considerations

Nutrition specialists should ensure that all interventions are documented to support billing.

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, but E46 remains a catch-all for unspecified cases. This can lead to challenges in capturing the severity and underlying causes of malnutrition, impacting treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malnutrition types, but E46 remains a catch-all for unspecified cases. This can lead to challenges in capturing the severity and underlying causes of malnutrition, impacting treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between E46 and E40/E41?

E46 is used when the specific type of protein-calorie malnutrition is not documented, while E40 and E41 are used for kwashiorkor and marasmus, respectively. Accurate documentation is crucial for proper coding.