Never, ever let a diagnosis of Kwashiorkor or Nutritional Marasmus out the door without a diagnosis specific review.
It’s so rare a diagnosis as to be almost always used incorrectly. With the exception of immigrants from the developing world, seeing either condition in your community should set off all sorts of public health red flags—-social service, child protective services, elder neglect hotline. If one of those codes are submitted and there’s no documentation of those resources being mobilized, your organization has provided very poor care.
Make sure you have a set of objective internal diagnostic criteria that must be documented before either diagnosis is submitted. If your clinician's documentation is insufficient, send it back to them for review. If you send it back though, be sure you don’t send along information that could be construed as leading or guiding your clinician to a different specific code. Eventually your clinicians will get the picture and stop submitting the problematic codes in favor of ones that are more accurate that your organization won't reject.
You absolutely must assume these diagnoses are going to be audited. Kwashiorkor and Marasmus are examples of two rare diagnoses associated with increased payments that are easy for auditors to target. Addressing the challenge pro-actively will send a message to auditors that they should move on to more fruitful fields---that is, providers who don't do such a good job of pre-submission code vetting. You'll be able to book your revenue with confidence that it will be retained and never clawed back.
A special caveat.
While uncommon in the developing world, these codes ARE common in refugee populations, especially upon their initial presentation for care---I've seen it. If a patient has one of these conditions, by all means submit it—-but do yourself a favor and make sure your documentation is up to snuff, because an audit is guaranteed.