2027 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 2027 (October 1, 2026 through September 30, 2027) 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. Coders also document this condition as chronic disease-related malnutrition. 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 2027.
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 2027 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
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to E43: its own notes plus those printed at block E40-E46 and Chapter 4. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Starvation edema
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name E43, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming E43: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming E43: its condition is not part of those codes, and both may be reported when the patient has both.
Code First 3
These codes say to code first a condition named in the note, and E43 is one of the conditions named.
Code Also 2
These codes say E43 may also be needed to fully describe the condition. The note gives no sequencing direction.
Notes 1
These notes mention E43.
- E64 Sequelae of malnutrition and other nutritional deficienciesThis category is to be used to indicate conditions in categories E43, E44, E46, E50-E63 as the cause of sequelae, which are themselves classified elsewhere. The 'sequelae' include conditions specified as such; they also include the late effects of diseases classifiable to the above categories if the disease itself is no longer present
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.
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, 2026 through September 30, 2027.
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, 2026 through September 30, 2027.
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 793, 791, 641, 640, with relative weights from 0.7864 to 4.2192 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 2027. 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.
Can E43 be reported with a code from K90?
Not as a rule. The Excludes1 note at block E40-E46, which applies to E43, lists "intestinal malabsorption (K90.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
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).
