Excludes1 pair
E41 vs E88.A
E41 and E88.A 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 E88.A
nutritional marasmus (E41)
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
E88.A
Wasting disease (syndrome) due to underlying condition
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E70-E88
Use when the record says
- Cachexia due to underlying condition
Indexed under
- Disease, diseased › wasting NEC
- Syndrome › wasting due to underlying condition (syndrome)
- Wasting › disease (syndrome)
- Cachexia › due to › malnutrition
- Cachexia › due to › underlying condition
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