FY2027
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Excludes1 pair

E40 vs E42

E40 and E42 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on E40
marasmic kwashiorkor (E42)
E40

Kwashiorkor

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E40-E46
Use when the record says
  • Severe malnutrition with nutritional edema with dyspigmentation of skin and hair
Indexed under
  • Kwashiorkor
  • Pluricarential syndrome of infancy
  • Polycarential syndrome of infancy
  • Malnutrition › malignant
  • Syndrome › pluricarential of infancy
E42

Marasmic kwashiorkor

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E40-E46
Use when the record says
  • Intermediate form severe protein-calorie malnutrition
  • Severe protein-calorie malnutrition with signs of both kwashiorkor and marasmus
Indexed under
  • Kwashiorkor › marasmic, marasmus type
  • Malnutrition › severe › intermediate form
  • Deficiency, deficient › calorie, severe › with marasmus › and kwashiorkor
  • Malnutrition › degree › severe › intermediate form
  • Malnutrition › protein › calorie › severe › intermediate form

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027