ICD-10 E43
Billable / Specific HCC v28: 21 MCCUnspecified severe protein-calorie malnutrition
About ICD-10-CM E43
ICD-10-CM code E43 represents Unspecified severe protein-calorie malnutrition. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E43). The 2026 edition of ICD-10-CM E43 became effective on October 1, 2025.
Coding Tips for E43
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E43 is a CMS-HCC v28 risk-adjustment code (category 21). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
E43 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under E43. Per CMS ICD-10-CM Tabular 2026.
- Starvation edema
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
codes Unspecified severe protein-calorie malnutrition. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for E43
Local Coverage Determinations (LCDs) from CMS MACs that list E43 as a covered diagnosis.
Showing top 10 of 152 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E43.
2 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with E43
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert E43 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| E43 | 262 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E43
Other codes in section E40-E46 (Malnutrition).
ICD-10 E43, Billing FAQ
Is ICD-10 code E43 billable? +
Yes, E43 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to E43? +
ICD-10 E43 includes: Starvation edema.
Does E43 affect Medicare Advantage HCC risk adjustment? +
Yes. E43 maps to CMS-HCC v28 category 21. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E43 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does E43 map to? +
Per CMS GEMs, E43 maps to ICD-9 codes: 262. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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