Cachexia and Malnutrition


Seeking guidance from the group. At our organization, CDI and Coding continue to go back and forth on a patient with malnutrition and cachexia. Can both codes be reported or just malnutrition as cachexia is a symptom of malnutrition?

Our CDI perspective is that cachexia, although a symptom code, is rather a disease=muscle wasting. Patients with malnutrition can be with or without cachexia. if the provider documents malnutrition with cachexia and frailty, then they can all be coded.

Coding's response: Wasting is a sign or symptom of undernutrition (malnutrition)

Definition of wasting: causing a person or a part of the body to become progressively weaker and more emaciated.

Definition of emaciation: the state of being abnormally thin or weak

Definition of cachexia: weakness or wasting of the body due to severe chronic illness.

All these things are closely related and are coded to the same thing, an R-code, a sign or symptom code.

The first coding guideline under the signs and symptoms chapter says:

  1. Use of symptom codes. Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

Based on this coding definition we should not be coding R64 with malnutrition.

I also found this Coding Clinic, (which I’m sure we’ve talked about before) 2013 1Q p13-14. Please note the highlighted area,

Question: Can we report the code for emaciation (code 261), if the physician only documents emaciated? Some coders do not feel that it is appropriate to report code 261, Nutritional marasmus, for the diagnosis of emaciated, since there is no specific index entry for emaciated. Other coders feel that "emaciation" and "emaciated" are the same conditions, and therefore, code 261 is appropriate for the diagnosis of emaciated. This code assignment can be located under:

 Emaciation (due to malnutrition) 261

 Answer: No, it is not correct to assign code 261, Nutritional marasmus, if the physician only documents emaciated or emaciation without the documentation of "malnutrition." Assign code 799.4, Cachexia, for a diagnosis of emaciated/emaciation. If the provider intended to describe malnutrition, then it should be documented as such. Marasmus is a type of protein energy malnutrition that is caused by a severe calorie deficiency, mostly occurring in young children. Whereas, emaciated is a descriptive term, meaning unusually thin due to wasting. Although the Index currently refers to code 261, a basic rule of coding is that further research is done if the title of the code suggested by the Index does not identify the condition correctly. Because of the code-set freeze in effect, and the limited time in which ICD- 9-CM will remain, no revisions can be made to the Index entry for emaciation.

Any advice is welcome,

, Beth Vorachek RN, MSN, CDI ,CCDS



  • Hello Beth,

    Recently I was working on some education and came across this issue. Cachexia is considered a separate condition from malnutrition and can be reported separately. This is similar to jaundice within gallbladder obstruction. Both can still be reported as it is "sometimes" seen within gallbladder obstruction, but not as a routine sign and symptom. This also applies to cachexia. Cachexia is a significant level of wasting and is not always found within malnutrition. Hope that helps.

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