Excludes1 pair
E41 vs E42
E41 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 E41
marasmic kwashiorkor (E42)
E41
Nutritional marasmus
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E40-E46
Use when the record says
- Severe malnutrition with marasmus
Indexed under
- Athrepsia
- Marasmus
- Pedatrophia
- Atrophy, atrophic › infantile
- Marasmus › due to malnutrition
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