March is National Nutrition Month.
In honor of National Nutrition Month (March), here is a review of weight-related diagnoses. The Official Coding and Reporting Guidelines for ICD-10-CM state that other clinicians may document body mass index (BMI), but the provider must document the weight diagnosis. The BMI codes are found in category Z68, which includes codes for pediatric and adult BMI.
There are four levels to obesity, including the following:
|
Level |
ICD-10-CM Code |
BMI Range |
|
Overweight |
E66.3 |
25.0 – 29.9 |
|
Low-risk Class 1 |
Category E66 |
30.0 – 34.9 |
|
Moderate-risk Class 2 |
Category E66 |
35.0 – 39.9 |
|
High-risk Class 3 |
E66.01 |
>= 40 |
Note that ICD-10-CM does not contain specific codes for Class 1 and Class 2 obesity.
Malnutrition levels are covered in the range E40 – E46. Kwashiorkor is severe malnutrition with nutritional edema and dyspigmentation of skin and hair. This condition rarely occurs in the U.S., but has been a focus of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). It is assigned E40. E41 is nutritional marasmus, which is a type of severe malnutrition that occurs in young children and infants. The symptoms are dehydration, chronic diarrhea, and stomach shrinkage. E42 is marasmic kwashiorkor, which is an intermediate form of severe malnutrition and has signs of kwashiorkor and marasmus. E43 is unspecified severe malnutrition. Payers often look for documentation of muscle wasting or cachexia when this diagnosis is assigned. The severe malnutrition codes are for major complications/comorbid conditions (MCCs), which is why they draw the attention of the payers and governmental agencies. The documentation of this condition must be strongly supported with clinical indicators to avoid a reduction in the assigned Diagnosis-Related Groups (DRGs). This is especially true if severe malnutrition is the only MCC/CC for the case.
The diagnosis codes of E44.0 (moderate malnutrition), E44.1 (mild malnutrition), and E46 (malnutrition, unspecified) complete the section of malnutrition. These malnutrition codes are classified as CCs.
There is also a code for being underweight (R63.6). The diagnosis codes for failure to thrive are divided into P92.6 for newborn, R62.51 for a child over 28-days, and R62.7 for adults.
It is important that your facility-specific coding guidelines address the documentation of BMI for code assignment. When determining the guideline, consider at what point in the patient’s stay the BMI should be captured. Admission? Discharge? Many electronic health records automatically calculate BMI, but this diagnosis code cannot be reported unless the provider documents the weight diagnosis.
Programming Note: Listen to Laurie Johnson every Tuesday for her coding report on Talk Ten Tuesdays, 10 a.m. Eastern.
Resources:
2021 ICD-10-CM Manual
2021 Official Coding and Reporting Guidelines for ICD-10-CM
https://journal.ahima.org/developing-facility-specific-coding-guidelines/
Hospitals nationwide are preparing for significant regulatory shifts driven by the Centers for Medicare & Medicaid Services (CMS). The FY 2026 Inpatient Prospective Payment System
MedLearn Media is launching an online resource believed to be useful for professional coders, charge capture, compliance, and revenue integrity specialists alike. DrugCode Pro is
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
