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ICD-10 Coding for Cholesterolemia(E78.00, E78.01)

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

Also known as:

High CholesterolHypercholesterolemiaFamilial Hypercholesterolemia

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Related ICD-10 Code Ranges

Complete code families applicable to Cholesterolemia

E78.0-E78.5Primary Range

Disorders of lipoprotein metabolism and other lipidemias

This range includes all relevant codes for various types of hypercholesterolemia and related lipid disorders.

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 LDL-C is elevated without specific familial or mixed lipid disorder.
  • LDL-C ≥190 mg/dL
  • Exclusion of secondary causes
E78.01Familial hypercholesterolemiaUse when familial history or genetic testing confirms hypercholesterolemia.
  • LDL-C ≥190 mg/dL
  • Family history of premature ASCVD or genetic confirmation

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 cholesterolemia

Essential facts and insights about Cholesterolemia

The ICD-10 code for unspecified pure hypercholesterolemia is E78.00, while familial hypercholesterolemia is coded as E78.01.

Primary ICD-10-CM Codes for cholesterolemia

E78.00
Pure hypercholesterolemia, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • LDL-C ≥190 mg/dL without triglyceride elevation

Applicable To

  • High cholesterol
  • Elevated LDL without triglyceride elevation

Excludes

  • Familial hypercholesterolemia (E78.01)

Clinical Validation Requirements

  • LDL-C ≥190 mg/dL
  • Exclusion of secondary causes

Code-Specific Risks

  • Misclassification if familial or mixed disorder is present

Coding Notes

  • Ensure documentation supports pure hypercholesterolemia without familial or mixed characteristics.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Screening for lipid disorders

Z13.220
Use for routine screening without prior diagnosis

Differential Codes

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

Familial hypercholesterolemia

E78.01
Presence of family history or genetic confirmation

Pure hypercholesterolemia, unspecified

E78.00
No family history or genetic confirmation

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Cholesterolemia 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: Non-compliance with documentation standards, Financial: Potential claim denials

Mitigation Strategy

Use specific terms like 'pure hypercholesterolemia' or 'familial hypercholesterolemia', Include lab results in documentation

Impact

Reimbursement: Potential denial of claims due to incorrect coding, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate patient records and statistics

Mitigation Strategy

Ensure family history or genetic testing is documented for E78.01

Impact

Using E78.00 without supporting documentation can trigger audits.

Mitigation Strategy

Ensure documentation includes specific LDL-C levels and excludes secondary causes.

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 Cholesterolemia, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Cholesterolemia

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

Documenting a new diagnosis of hypercholesterolemia

Specialty: Primary Care

Required Elements

  • Patient's lipid panel results
  • Family history of cardiovascular disease
  • Exclusion of secondary causes

Example Documentation

Patient presents with LDL-C 210 mg/dL. No secondary causes identified. Family history of early heart disease noted. Diagnosis: Familial hypercholesterolemia (E78.01).

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has high cholesterol.
Good Documentation Example
LDL-C 210 mg/dL, no secondary causes, family history of early heart disease. Diagnosis: Familial hypercholesterolemia (E78.01).
Explanation
The good example provides specific lab values and family history, supporting the diagnosis.

Need help with ICD-10 coding for Cholesterolemia? Ask your questions below.

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