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ICD-10 Coding for Abnormal Cholesterol Level(E78.00, E78.2, E78.5)

Complete ICD-10-CM coding and documentation guide for Abnormal Cholesterol Level. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

HypercholesterolemiaHyperlipidemiaDyslipidemia

Related ICD-10 Code Ranges

Complete code families applicable to Abnormal Cholesterol Level

E78.0-E78.5Primary Range

Disorders of lipoprotein metabolism and other lipidemias

This range includes codes for various types of hyperlipidemia, including hypercholesterolemia and mixed hyperlipidemia.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
E78.00Pure hypercholesterolemia, unspecifiedUse when managing cholesterol-specific therapy with LDL-C ≥190 mg/dL.
  • LDL-C ≥190 mg/dL without elevated triglycerides or secondary causes
E78.2Mixed hyperlipidemiaUse when both LDL and triglycerides are elevated and documented.
  • LDL-C ≥160 mg/dL and triglycerides ≥150 mg/dL
E78.5Unspecified hyperlipidemiaUse when specific type of hyperlipidemia is not documented.
  • Abnormal lipid panel without specific type documented

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for abnormal cholesterol levels

Essential facts and insights about Abnormal Cholesterol Level

The ICD-10 code for abnormal cholesterol levels includes E78.00 for pure hypercholesterolemia and E78.2 for mixed hyperlipidemia.

Primary ICD-10-CM Codes for abnormal cholesterol level

Pure hypercholesterolemia, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • LDL-C ≥190 mg/dL confirmed on two separate occasions.

Applicable To

  • Primary hypercholesterolemia

Excludes

  • Familial hypercholesterolemia (E78.01)

Clinical Validation Requirements

  • LDL-C ≥190 mg/dL without elevated triglycerides or secondary causes

Code-Specific Risks

  • Incorrect use if triglycerides are elevated.

Coding Notes

  • Ensure LDL-C levels are documented and secondary causes are ruled out.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Familial hypercholesterolemia

E78.01
Requires genetic testing or family history of premature ASCVD.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Abnormal Cholesterol Level to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E78.00.

Impact

Clinical: May lead to inappropriate treatment plans., Regulatory: Potential audit issues., Financial: Risk of claim denials.

Mitigation Strategy

Review lab results for specific lipid abnormalities., Consult with the provider for clarification if needed.

Impact

Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and statistics.

Mitigation Strategy

Ensure both LDL and triglyceride levels meet criteria before coding E78.2.

Impact

Frequent use of E78.5 without specific lipid documentation.

Mitigation Strategy

Implement EHR alerts for specific lipid documentation.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Abnormal Cholesterol Level, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Abnormal Cholesterol Level

Use these documentation templates to ensure complete and accurate documentation for Abnormal Cholesterol Level. These templates include all required elements for proper coding and billing.

Cholesterol management follow-up

Specialty: Cardiology

Required Elements

  • Patient history
  • Lipid panel results
  • Treatment plan
  • Provider signature

Example Documentation

Patient presents with primary hypercholesterolemia: LDL-C 215 mg/dL (ref <100), HDL 42, TG 110. No secondary causes identified. Family history of premature CAD. Plan: Initiate high-intensity statin.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Elevated cholesterol. Start lipid therapy.
Good Documentation Example
LDL-C 215 mg/dL (ref <100), HDL 42, TG 110. No secondary causes. Family history of premature CAD. Plan: High-intensity statin.
Explanation
The good example includes specific lipid values, family history, and a detailed plan.

Need help with ICD-10 coding for Abnormal Cholesterol Level? Ask your questions below.

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