2026 ICD-10-CM Diagnosis Code E43Unspecified severe protein-calorie malnutrition
ICD-10-CM Codes›E00–E89›E40-E46›E43
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Chronic Condition
E43 is a billable ICD-10-CM diagnosis code for unspecified severe protein-calorie malnutrition. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 640 through 641, 791, 793. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 9 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Malnutrition.
E43 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 21 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 21, ESRD (V21) category 21, and ESRD (V24) category 21 for payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
E43 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Chronic disease-related malnutrition
- Edema co-occurrent and due to nutritional deficiency
- GLIM stage 2 severe malnutrition
- Malnutrition
- Nutritional edema without dyspigmentation of skin AND/OR hair
- Semi-starvation
- Severe malnutrition due to type 1 diabetes mellitus
- Severe malnutrition due to type 2 diabetes mellitus
- Severe protein-calorie malnutrition
- Starvation
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Starvation edema
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
nutritional E43
Disease, diseased See Also: Syndrome;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Starvation
lengthy and continuous deprivation of food. (stedman, 25th ed)Child Nutrition Disorders
disorders caused by nutritional imbalance, either overnutrition or undernutrition, occurring in children ages 2 to 12 years.Fetal Nutrition Disorders
disorders caused by nutritional imbalance, either overnutrition or undernutrition, in the fetus in utero.Infant Nutrition Disorders
disorders caused by nutritional imbalance, either overnutrition or undernutrition, occurring in infants ages 1 month to 24 months.Malnutrition
an imbalanced nutritional status resulting from insufficient intake of nutrients to meet normal physiological requirement.Protein-Energy Malnutrition
the lack of sufficient energy or protein to meet the body's metabolic demands, as a result of either an inadequate dietary intake of protein, intake of poor quality dietary protein, increased demands due to disease, or increased nutrient losses.Severe Acute Malnutrition
acute form of malnutrition which usually affects children, characterized by a very low weight for height (below -3z scores of the median world health organization standards), visible severe wasting, or occurrence of nutritional edema. it can be a direct or indirect cause of fatality in children suffering from diarrhea and pneumonia. do not confuse with starvation, a condition in which the body is not getting enough food, usually for extended periods of time.Fetus
the unborn young of a viviparous mammal, in the postembryonic period, after the major structures have been outlined. in humans, the unborn young from the end of the eighth week after conception until birth, as distinguished from the earlier embryo, mammalian.
Patient EducationClinical
Malnutrition
Malnutrition means that your body isn't getting enough calories or the right balance of nutrients to stay healthy. This can happen if you don't get enough protein, carbohydrates, and fats, eat too much unhealthy food, or don't get the vitamins and minerals your body needs.
The full article covers:
- What is malnutrition?
- What are the types of malnutrition?
- What causes malnutrition?
- Who is at risk for developing malnutrition?
- What are the symptoms of malnutrition?
- How is malnutrition diagnosed?
- What are the treatments for malnutrition?
- Can malnutrition be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert E43 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About E43Overview
What is the ICD-10 code for unspecified severe protein-calorie malnutrition?
The ICD-10-CM code for unspecified severe protein-calorie malnutrition is E43. It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is E43 (Unspecified severe protein-calorie malnutrition) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report unspecified severe protein-calorie malnutrition on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does E43 group to?
When unspecified severe protein-calorie malnutrition is the principal diagnosis on an inpatient stay, it groups to MS-DRG 640, 641, 791, 793, with relative weights from 0.7782 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.
Is E43 a CC or MCC?
CMS lists E43 as an MCC (major complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 9 closely related codes in its exclusion list.
What is the ICD-9 equivalent of E43?
Under the General Equivalence Mappings, unspecified severe protein-calorie malnutrition converts to ICD-9-CM 262 (oth severe malnutrition). The mapping is approximate, so confirm the match fits the documentation.
Does E43 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. E43 mapped to HCC 21 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 21 (Protein-Calorie Malnutrition), ESRD (V21) category 21 (Protein-Calorie Malnutrition), and ESRD (V24) category 21 (Protein-Calorie Malnutrition).
