MS-DRG · FY 2026 v43.0

MS-DRG 640 – Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC

A Medical DRG in MDC 10 (Endocrine, Nutritional & Metabolic Diseases & Disorders). Inpatient cases group to DRG 640 when the ICD-10-CM principal diagnosis is one of the 130 codes listed below and a secondary diagnosis on the major complication or comorbidity (MCC) list is present. Its FY 2026 relative weight is 1.3356 with a geometric mean length of stay of 3.6 days.

Medical DRG – assigned by principal diagnosis✓ Official CMS v43.0 dataset
1.3356
Relative Weight
3.6
Geometric Mean LOS (days)
5.0
Arithmetic Mean LOS (days)
130
Principal Diagnosis Codes

Severity family

DRG 640with MCCWeight 1.3356 · GMLOS 3.6 daysDRG 641without MCCWeight 0.7782 · GMLOS 2.6 days
How a case is assigned to DRG 640

The grouper first assigns the case to MDC 10 from the principal diagnosis and finds no qualifying operating-room procedure (this is a Medical DRG; ICD-10-PCS codes do not drive assignment here), then applies the severity split from secondary diagnoses: with MCC → 640; without MCC → 641.

ICD-10-CM

Principal Diagnosis Codes 130 codes · 40 categories

130 of 130 shown
D81 Combined immunodeficiencies2 codes
  • D81.818 Other biotin-dependent carboxylase deficiency
  • D81.819 Biotin-dependent carboxylase deficiency, unspecified
E15 Nondiabetic hypoglycemic coma1 code
  • E15 Nondiabetic hypoglycemic coma
E16 Other disorders of pancreatic internal secretion1 code
  • E16.2 Hypoglycemia, unspecified
E20 Hypoparathyroidism1 code
  • E20.1 Pseudohypoparathyroidism
E40 Kwashiorkor1 code
  • E40 Kwashiorkor
E41 Nutritional marasmus1 code
  • E41 Nutritional marasmus
E42 Marasmic kwashiorkor1 code
  • E42 Marasmic kwashiorkor
E43 Unspecified severe protein-calorie malnutrition1 code
  • E43 Unspecified severe protein-calorie malnutrition
E44 Protein-calorie malnutrition of moderate and mild degree2 codes
  • E44.0 Moderate protein-calorie malnutrition
  • E44.1 Mild protein-calorie malnutrition
E45 Retarded development following protein-calorie malnutrition1 code
  • E45 Retarded development following protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition1 code
  • E46 Unspecified protein-calorie malnutrition
E50 Vitamin A deficiency2 codes
  • E50.8 Other manifestations of vitamin A deficiency
  • E50.9 Vitamin A deficiency, unspecified
E51 Thiamine deficiency5 codes
  • E51.11 Dry beriberi
  • E51.12 Wet beriberi
  • E51.2 Wernicke's encephalopathy
  • E51.8 Other manifestations of thiamine deficiency
  • E51.9 Thiamine deficiency, unspecified
E52 Niacin deficiency [pellagra]1 code
  • E52 Niacin deficiency [pellagra]
E53 Deficiency of other B group vitamins4 codes
  • E53.0 Riboflavin deficiency
  • E53.1 Pyridoxine deficiency
  • E53.8 Deficiency of other specified B group vitamins
  • E53.9 Vitamin B deficiency, unspecified
E54 Ascorbic acid deficiency1 code
  • E54 Ascorbic acid deficiency
E55 Vitamin D deficiency1 code
  • E55.9 Vitamin D deficiency, unspecified
E56 Other vitamin deficiencies4 codes
  • E56.0 Deficiency of vitamin E
  • E56.1 Deficiency of vitamin K
  • E56.8 Deficiency of other vitamins
  • E56.9 Vitamin deficiency, unspecified
E58 Dietary calcium deficiency1 code
  • E58 Dietary calcium deficiency
E59 Dietary selenium deficiency1 code
  • E59 Dietary selenium deficiency
E60 Dietary zinc deficiency1 code
  • E60 Dietary zinc deficiency
E61 Deficiency of other nutrient elements10 codes
  • E61.0 Copper deficiency
  • E61.1 Iron deficiency
  • E61.2 Magnesium deficiency
  • E61.3 Manganese deficiency
  • E61.4 Chromium deficiency
  • E61.5 Molybdenum deficiency
  • E61.6 Vanadium deficiency
  • E61.7 Deficiency of multiple nutrient elements
  • E61.8 Deficiency of other specified nutrient elements
  • E61.9 Deficiency of nutrient element, unspecified
E63 Other nutritional deficiencies4 codes
  • E63.0 Essential fatty acid [EFA] deficiency
  • E63.1 Imbalance of constituents of food intake
  • E63.8 Other specified nutritional deficiencies
  • E63.9 Nutritional deficiency, unspecified
E64 Sequelae of malnutrition and other nutritional deficiencies5 codes
  • E64.0 Sequelae of protein-calorie malnutrition
  • E64.1 Sequelae of vitamin A deficiency
  • E64.2 Sequelae of vitamin C deficiency
  • E64.8 Sequelae of other nutritional deficiencies
  • E64.9 Sequelae of unspecified nutritional deficiency
E65 Localized adiposity1 code
  • E65 Localized adiposity
E66 Overweight and obesity9 codes
  • E66.01 Morbid (severe) obesity due to excess calories
  • E66.09 Other obesity due to excess calories
  • E66.1 Drug-induced obesity
  • E66.3 Overweight
  • E66.811 Obesity, class 1
  • E66.812 Obesity, class 2
  • E66.813 Obesity, class 3
  • E66.89 Other obesity not elsewhere classified
  • E66.9 Obesity, unspecified
E67 Other hyperalimentation5 codes
  • E67.0 Hypervitaminosis A
  • E67.1 Hypercarotenemia
  • E67.2 Megavitamin-B6 syndrome
  • E67.3 Hypervitaminosis D
  • E67.8 Other specified hyperalimentation
E68 Sequelae of hyperalimentation1 code
  • E68 Sequelae of hyperalimentation
E83 Disorders of mineral metabolism9 codes
  • E83.40 Disorders of magnesium metabolism, unspecified
  • E83.41 Hypermagnesemia
  • E83.42 Hypomagnesemia
  • E83.49 Other disorders of magnesium metabolism
  • E83.50 Unspecified disorder of calcium metabolism
  • E83.51 Hypocalcemia
  • E83.52 Hypercalcemia
  • E83.59 Other disorders of calcium metabolism
  • E83.81 Hungry bone syndrome
E84 Cystic fibrosis2 codes
  • E84.8 Cystic fibrosis with other manifestations
  • E84.9 Cystic fibrosis, unspecified
E86 Volume depletion3 codes
E87 Other disorders of fluid, electrolyte and acid-base balance14 codes
  • E87.0 Hyperosmolality and hypernatremia
  • E87.1 Hypo-osmolality and hyponatremia
  • E87.20 Acidosis, unspecified
  • E87.21 Acute metabolic acidosis
  • E87.22 Chronic metabolic acidosis
  • E87.29 Other acidosis
  • E87.3 Alkalosis
  • E87.4 Mixed disorder of acid-base balance
  • E87.5 Hyperkalemia
  • E87.6 Hypokalemia
  • E87.70 Fluid overload, unspecified
  • E87.71 Transfusion associated circulatory overload
  • E87.79 Other fluid overload
  • E87.8 Other disorders of electrolyte and fluid balance, not elsewhere classified
E89 Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified1 code
  • E89.1 Postprocedural hypoinsulinemia
P92 Feeding problems of newborn1 code
  • P92.6 Failure to thrive in newborn
R29 Other symptoms and signs involving the nervous and musculoskeletal systems1 code
R62 Lack of expected normal physiological development in childhood and adults6 codes
  • R62.0 Delayed milestone in childhood
  • R62.50 Unspecified lack of expected normal physiological development in childhood
  • R62.51 Failure to thrive (child)
  • R62.52 Short stature (child)
  • R62.59 Other lack of expected normal physiological development in childhood
  • R62.7 Adult failure to thrive
R63 Symptoms and signs concerning food and fluid intake11 codes
  • R63.0 Anorexia
  • R63.1 Polydipsia
  • R63.2 Polyphagia
  • R63.30 Feeding difficulties, unspecified
  • R63.31 Pediatric feeding disorder, acute
  • R63.32 Pediatric feeding disorder, chronic
  • R63.39 Other feeding difficulties
  • R63.4 Abnormal weight loss
  • R63.5 Abnormal weight gain
  • R63.6 Underweight
  • R63.8 Other symptoms and signs concerning food and fluid intake
R73 Elevated blood glucose level5 codes
  • R73.01 Impaired fasting glucose
  • R73.02 Impaired glucose tolerance (oral)
  • R73.03 Prediabetes
  • R73.09 Other abnormal glucose
  • R73.9 Hyperglycemia, unspecified
R82 Other and unspecified abnormal findings in urine1 code
Z68 Body mass index [BMI]7 codes
  • Z68.41 Body mass index [BMI] 40.0-44.9, adult
  • Z68.42 Body mass index [BMI] 45.0-49.9, adult
  • Z68.43 Body mass index [BMI] 50.0-59.9, adult
  • Z68.44 Body mass index [BMI] 60.0-69.9, adult
  • Z68.45 Body mass index [BMI] 70 or greater, adult
  • Z68.55 Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age
  • Z68.56 Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age
ICD-10-PCS

Procedure Codes

Procedure codes do not drive assignment for this DRG. DRG 640 is a Medical DRG, assigned from the principal diagnosis above.

Frequently Asked Questions

What is MS-DRG 640?

MS-DRG 640 (Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC) is a medical DRG in MDC 10 (Endocrine, Nutritional & Metabolic Diseases & Disorders). Its FY 2026 relative weight is 1.3356 with a geometric mean length of stay of 3.6 days.

What is the difference between DRG 640, 641?

All 2 share the same base category; the severity of secondary diagnoses separates them: 640 (with MCC), 641 (without MCC). A major complication or comorbidity (MCC) places the case in the highest-weighted DRG of the family; a CC in the middle; neither in the lowest.

How many diagnosis codes group to DRG 640?

130 ICD-10-CM principal diagnosis codes group to this DRG, spanning 40 three-character categories.

What is the relative weight of DRG 640?

The FY 2026 relative weight of this DRG is 1.3356, meaning reimbursement of roughly 1.34 times the average Medicare inpatient case. Multiply by a hospital's blended base rate for the approximate payment.

← PreviousDRG 639 – Diabetes without CC/MCC
Source: CMS ICD-10 MS-DRG v43.0 Definitions Manual and the FY 2026 IPPS Final Rule (Table 5), effective October 1, 2025 through September 30, 2026. We publish the DRG assignments as CMS defines them and add the navigation, search, and code links.