OC TOBER 2010
Informative and educational updates for providers
FOCUS ON: Protein-Calorie
Malnutrition
This is an energy deficit due to a chronic deficiency of all
macronutrients and many micronutrients. In developed countries,
it is primarily seen in people with other illnesses and in the
institutionalized elderly.1 The disorders that may exist in conjunction
with, and contribute to, protein calorie malnutrition include disorders
that impair absorption or metabolism or decrease appetite such
as: chronic pancreatitis, chronic liver disease, cancer, ESRD and
substance abuse.2 While there is no definitive diagnostic test for PCM,
the subjective global assessment consists of six parameters and the
clinician’s judgment as to whether PCM exists:3
a. Unremitting involuntary weight loss, especially greater than 10% of prior weight
b. Severely curtailed food intake
c. Muscle wasting or fat loss (with edema and ascites on physical exam)
d. Persistent GI symptoms such as anorexia, emesis or diarrhea
e. Marked reduction in physical capacity
f. Metabolic stress such as in sepsis or trauma
Any combination of these is an indicator of PCM.
ICD-9
Code
Code
Description
263.0
Malnutrition of
Moderate Degree
263.1
263.8
263.9
799.4
Diagnostic
Criteria
“Second Degree” Characterized
by superimposed biochemical
changes in electrolytes, lipids,
blood plasma4,5
Malnutrition of Mild “First Degree” Characterized by
degree
tissue wasting in an adult, but
few or no biochemical changes4
Other Protein
Not elsewhere specified4
Calorie Malnutrition
Unspecified Protein Dystrophy due to malnutrition
Calorie Malnutrition
Malnutrition (calorie) NOS5
Cachexia
Wasting disease; general ill
health and poor nutrition.4
Code first for underlying
condition if known.5
The information presented herein is for informational purposes only. It is not intended, nor is it to be
used, to define a standard of care or otherwise substitute for informed medical evaluation, diagnosis and
treatment which can only be performed by a qualified medical professional. Ingenix, Inc. does not warrant
or represent that the information contained herein is accurate or free from defects.
This information is for informational purposes only and does not replace the professional judgment and
expertise of the individual performing coding based on numerous factors including, but not limited to,
documentation in the medical record and other industry recognized coding guidance. Because codes,
coding requirements and standards can and do change, the individual assigning codes is reminded to
verify the accuracy, specificity, currency and acceptability of such codes and coding methods used.
Always…
• Document to the greatest degree of certainty based on
your clinical judgment as to whether PCM exists.
• When documenting cachexia or wasting disease,
remember to document and report first the underlying
condition as well.
Documentation and Coding Tips5
• Be careful not to document protein-calorie malnutrition
as:
• Abnormal Weight Loss 783.21
• Loss of Appetite 783.0
• Underweight
783.22
• Anorexia
783.0
• Failure to Thrive (Adult)
783.7
These are categorized as Symptoms, Signs and Ill-Defined
Conditions in the ICD-9-CM and do not report the
patient’s condition to the greatest degree of specificity.
• Protein-calorie malnutrition can be documented by
degree in two ways:
• Mild, moderate, severe
• First, second, third
• Wasting disease due to malnutrition is coded as 261 –
Nutritional marasmus and includes nutritional atrophy,
severe calorie deficiency and severe malnutrition, not
otherwise specified.
• Protein-calorie malnutrition that is documented as severe
or third degree is coded as 262 - Other severe proteincalorie malnutrition and includes nutritional edema
without mention of dyspigmentation of skin and hair.
• Nutritional edema with dyspigmentation of skin and hair
is coded as 260 – Kwashiorkor.
1 http://www.merck.com/mmpe/sec01/ch002/ch002b.html
2 CMAJ, Nov 13, 2001 “Clinical nutrition: Protein energy malnutrition in inpatient settings”
3 HHS and CMS: (Aug. 2008) Intent and definitions: CMS Manual System Pub 100-07.
4 Ingenix 2010 Coders’ Desk Reference for Diagnoses. USA: Ingenix, 2009. Print., pp. 264, 648.
5 Ingenix 2010 ICD-9-CM Professional for Physicians. 6th ed. 2 vols. USA: Igenix, 2009. Print.
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