ICD-10 E64.0
Billable / Specific HCC v28: 21 CCSequelae of protein-calorie malnutrition
About ICD-10-CM E64.0
ICD-10-CM code E64.0 represents Sequelae of protein-calorie malnutrition. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E64). The 2026 edition of ICD-10-CM E64.0 became effective on October 1, 2025.
Coding Tips for E64.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E64.0 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.
E64.0 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 2 Excludes
Not included here, the excluded code is not part of E64.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- retarded development following protein-calorie malnutrition (E45)
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, CC
codes Sequelae of protein-calorie malnutrition. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for E64.0
Local Coverage Determinations (LCDs) from CMS MACs that list E64.0 as a covered diagnosis.
Showing top 10 of 203 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E64.0.
5 Medicare
Convert E64.0 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 |
|---|---|---|
| E64.0 | 2639 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E64.0
Other codes in section E50-E64 (Other nutritional deficiencies).
ICD-10 E64.0, Billing FAQ
Is ICD-10 code E64.0 billable? +
Yes, E64.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for E64.0? +
Type 2 Excludes (may be coded together when both conditions exist): retarded development following protein-calorie malnutrition (E45)
Does E64.0 affect Medicare Advantage HCC risk adjustment? +
Yes. E64.0 maps to CMS-HCC v28 category 21. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E64.0 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with E64.0? +
Procedures frequently paired with E64.0 include: J3420, J3425.
What ICD-9 codes does E64.0 map to? +
Per CMS GEMs, E64.0 maps to ICD-9 codes: 2639. 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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