As of 10/1/2020, when recommending emaciation as a diagnosis for admissions with discharge dates on or after 10/1/2020, the alphabetic index assigns Emaciation (due to malnutrition) to code E43 Unspecified severe protein-calorie malnutrition.

Prior to 10/1/2020, Emaciation was assigned to code E41 Nutritional marasmus. Coding Clinic 3Q, 2017, pgs 24-25 indicated that E41 should only be used for marasmus (a type of protein-energy malnutrition occurring in infants or young children, caused by a severe calorie deficiency.) If that condition was not applicable, the Coding Clinic stated that emaciation should be assigned code R64, Cachexia. This is no longer the case.

As such, the following Coding Clinic no longer applies:

Emaciation and malnutrition

CC, 3Q, 2017, pg 24-25

Question:

The ICD-10-CM Index for Diseases lists the following: Emaciation (due to malnutrition) E41. The Tabular List of Diseases lists E41 as Nutritional Marasmus. If a physician documents Emaciation, given that "due to malnutrition" is a nonessential modifier, the Index classifies the term "emaciation" as E41, Nutritional marasmus. If a physician documents "emaciation" without documenting malnutrition, would it be appropriate to assign code E41?

Answer:

First, it should be noted that marasmus by definition is a type of protein-energy malnutrition occurring in infants or young children, that is caused by a severe calorie deficiency. If that is not applicable for the case, then it is not correct to assign code E41, Nutritional marasmus, even if the physician only documents emaciated or emaciation without the documentation of "malnutrition." Assign code R64, Cachexia, for a diagnosis of emaciated/emaciation. If the provider intended to describe malnutrition, then it should be documented as such. Emaciated is a descriptive term, meaning unusually thin due to wasting. Although the Index currently refers to code E41, a basic rule of coding is that further research is done if the title of the code suggested by the Index does not identify the condition correctly.

Remember that ‘due to malnutrition’ is a nonessential modifier for this diagnosis. Prior to 10/1/2020, Emaciation was assigned to code E41 Nutritional marasmus. Coding Clinic 3Q, 2017, pgs 24-25 indicated that E41 should only be used for marasmus (a type of protein-energy malnutrition occurring in infants or young children, caused by a severe calorie deficiency.) If that condition was not applicable, we no longer should that assign code R64, Cachexia, but code E43 Unspecified severe protein-calorie malnutrition.

Get Your Free DRG Assessment

We will provide you a free, custom analysis, detailing the potential value of physician reviews at your facility.

Request Assessment