Unspecified protein-calorie malnutrition
In Malnutrition (E40-E46), chapter 4: Endocrine, Nutritional and Metabolic Diseases
- E46 is an unspecified code: use it only when the record doesn't document anything more specific. If the record has more detail, check the other codes under E40-E46 below.
- As a secondary diagnosis it is a CC (complication or comorbidity), which can raise the MS-DRG payment. It doesn't count when the principal diagnosis is one of 9 closely related codes.
- Doesn't count toward a Medicare Advantage risk score (no HCC in V28; it was HCC 21 in V24).
- AHRQ's Chronic Condition Indicator classes it as chronic: expected to last 12 months or longer and to limit daily life or need ongoing care.
- 8,816 US deaths in 2024 had an underlying cause in category E46, per the National Vital Statistics System on CDC WONDER. Death records use WHO ICD-10, so the count is for the whole category.
Also indexed as: Calorie deficiency or malnutrition; Cataract, in, malnutrition-dehydration; Cataract, malnutrition-dehydration; Deficiency, protein; Malnutrition; Malnutrition, protein; Malnutrition, protein, calorie; Malnutrition, protein, energy
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Instructional notes
Includes: conditions that are coded here
- Malnutrition NOS
- Protein-calorie imbalance NOS
Excludes1: not coded here, use a different code
- nutritional deficiency NOS (E63.9)
Also applies, from Malnutrition (E40-E46)
These notes sit on E40-E46 and apply to every code under it, including E46.
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers diabetes mellitus coding, including type, insulin and drug use, pump malfunction and secondary diabetes, plus obesity and obesity class codes.
- Diabetes mellitus (page 39)
- Obesity (page 42)
Other codes under E40-E46
Malnutrition (E40-E46)
E46 MS-DRGs
As the principal diagnosis, E46 groups to MS-DRG 640, 641, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
Related conditions
Grouped by AHRQ's Clinical Classifications Software Refined (CCSR), which sorts every diagnosis code into clinically meaningful categories.
E46 is in Malnutrition (END008, its default category), with 14 codes. Others in it:
- E40 Kwashiorkor
- E41 Nutritional marasmus
- E42 Marasmic kwashiorkor
- E43 Unspecified severe protein-calorie malnutrition
- E44.0 Moderate protein-calorie malnutrition
- E44.1 Mild protein-calorie malnutrition
- E45 Retarded development following protein-calorie malnutrition
- O25.10 Malnutrition in pregnancy, unspecified trimester
Medicare coverage articles listing E46
These 11 Medicare billing and coding articles list E46 as a diagnosis that supports medical necessity for the services they cover. From the CMS Medicare Coverage Database; check your own contractor's article before billing.
- Pharmacogenomics Testing (2 contractors)
- Routine Foot Care (2 contractors)
- Assays for Vitamins and Metabolic Function
- Diagnostic and Therapeutic Esophagogastroduodenoscopy
- Foot Care
- Magnesium
- Pharmacogenomic Testing
- Routine Foot Care and Debridement of Nails
- Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
- Upper Gastrointestinal Endoscopy and Visualization
And 1 more.
Other codes that refer to E46
Notes on these codes point to E46.
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
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.
Read more about malnutrition on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.
ICD-9-CM equivalent
Legacy crosswalk from the CMS General Equivalence Mappings (last updated 2018).
- 263.8 Other protein-calorie malnutrition (approximate)
- 263.9 Unspecified protein-calorie malnutrition (approximate)