E40-E46 ICD-10-CA block: Malnutrition

Note

• The degree of malnutrition is usually measured in terms of weight, expressed in standard deviations from the mean of the relevant reference population. When one or more previous measurements are available, lack of weight gain in children, or evidence of weight loss in children or adults, is usually indicative of malnutrition. When only one measurement is available, the diagnosis is based on probabilities and is not definitive without other clinical or laboratory tests. In the exceptional circumstances that no measurement of weight is available, reliance should be placed on clinical evidence.If an observed weight is below the mean value of the reference population, there is a high probability of severe malnutrition if there is an observed value situated 3 or more standard deviations below the mean value of the reference population; a high probability of moderate malnutrition for an observed value located between 2 and less than 3 standard deviations below this mean; and a high probability of mild malnutrition for an observed value located between 1 and less than 2 standard deviations below this mean.
• New coding direction for DAD and NACRS Whenever a diagnosis of malnutrition, classified to a code from the block Malnutrition (E40–E46), is documented, Assign the code for malnutrition, mandatory, as a significant diagnosis type/other problem when it meets the criteria for significance (refer to Diagnosis Typing Definitions for DAD ) or it is severe enough to warrant treatment with an intervention such as Total parenteral nutrition (TPN) Enteral nutrition Permanent endoscopic gastrostomy (PEG) tube (refer to example 1) Assign the code for malnutrition, mandatory, as a diagnosis type (3)/other problem (refer to example 2). Exceptions When malnutrition is diagnosed in pregnancy, refer to the coding standard Complicated Pregnancy Versus Uncomplicated Pregnancy. When malnutrition is diagnosed in the perinatal period, refer to the coding standard Low Birth Weight and/or Preterm Infant. Notes Terms that denote malnutrition include Caloric deficiency Energy supply deficiency Protein deficiency Undernourishment All available documentation — including non-physician documentation, such as that from regulated health professionals (e.g., dietitians, nutritionists) — may be used for code assignment.
• All neoplasms, whether functionally active or not, are classified in Chapter II. Appropriate codes in this chapter (i.e. E05.8)(E07.0) (E16-E31)(E34.-) may be used, if desired, 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.From Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E90)