ICD-10 E88.A
Billable / Specific HCC v28: 21Wasting disease (syndrome) due to underlying condition
About ICD-10-CM E88.A
ICD-10-CM code E88.A represents Wasting disease (syndrome) due to underlying condition. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E88). The 2026 edition of ICD-10-CM E88.A became effective on October 1, 2025.
Coding Tips for E88.A
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E88.A 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under E88.A. Per CMS ICD-10-CM Tabular 2026.
- Cachexia due to underlying condition
Type 1 Excludes
Pure excludes, these codes can never be coded together with E88.A. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- cachexia NOS (R64)
- nutritional marasmus (E41)
Type 2 Excludes
Not included here, the excluded code is not part of E88.A, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- failure to thrive (R62.51, R62.7)
Coding Notes
Code First
- underlying condition
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.
Medicare LCD Coverage for E88.A
Local Coverage Determinations (LCDs) from CMS MACs that list E88.A as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E88.A.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but E88.A doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with E88.A
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.
Codes Adjacent To E88.A
Other codes in section E70-E88 (Metabolic disorders).
ICD-10 E88.A, Billing FAQ
Is ICD-10 code E88.A billable? +
Yes, E88.A 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 E88.A? +
ICD-10 E88.A includes: Cachexia due to underlying condition.
What codes are Type 1 Excludes for E88.A? +
Type 1 Excludes (never code together with E88.A): cachexia NOS (R64); nutritional marasmus (E41)
What codes are Type 2 Excludes for E88.A? +
Type 2 Excludes (may be coded together when both conditions exist): failure to thrive (R62.51, R62.7)
Does E88.A affect Medicare Advantage HCC risk adjustment? +
Yes. E88.A maps to CMS-HCC v28 category 21. Capture this diagnosis annually for accurate Medicare Advantage risk score.
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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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