ICD-10 Coding for Familial Hyperlipidemia(E78.01, Z83.42)
Complete ICD-10-CM coding and documentation guide for Familial Hyperlipidemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Familial Hyperlipidemia
E78.0-E78.5Primary Range
Disorders of lipoprotein metabolism and other lipidemias
This range includes codes for various lipid metabolism disorders, with E78.01 specifically for familial hypercholesterolemia.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E78.01 | Familial hypercholesterolemia | Use when familial hypercholesterolemia is confirmed by genetic testing or clinical criteria. |
|
| Z83.42 | Family history of familial hypercholesterolemia | Use when documenting family history of FH without a confirmed diagnosis in the patient. |
|
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 familial hyperlipidemia
Essential facts and insights about Familial Hyperlipidemia
Primary ICD-10-CM Codes for familial hyperlipidemia
Decision Criteria
clinical Criteria
- LDL-C levels and genetic test results
documentation Criteria
- Specific mention of familial hypercholesterolemia
Applicable To
- Genetic hyperlipidemia
- LDL receptor defect
Excludes
- Secondary hyperlipidemia (E78.2)
Clinical Validation Requirements
- LDL-C ≥190 mg/dL in adults
- Genetic testing confirming LDLR/APOB/PCSK9 mutation
- Presence of tendon xanthomas
Code-Specific Risks
- Misclassification if genetic testing is not documented
- Incorrect sequencing with comorbid conditions
Coding Notes
- Ensure documentation specifies familial hypercholesterolemia and includes genetic or clinical validation.
Z83.42 - Family history of familial hypercholesterolemia
Use when documenting family history of FH without a confirmed diagnosis in the patient.
Clinical Validation Requirements
- Documented family history of FH in first-degree relatives
Coding Notes
Ensure family history is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Family history of familial hypercholesterolemia
Z83.42Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Familial Hyperlipidemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E78.01.
Impact
Clinical: Inaccurate risk assessment for cardiovascular events, Regulatory: Potential audit issues, Financial: Loss of reimbursement opportunities
Mitigation Strategy
Always document family history when relevant, Use templates to ensure completeness
Impact
Reimbursement: Potential underpayment due to incorrect coding, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data representation
Mitigation Strategy
Ensure documentation supports E78.01 with genetic or clinical criteria.
Impact
Using E78.5 instead of E78.01 for familial cases
Mitigation Strategy
Educate coders on the importance of genetic and clinical validation.
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 Familial Hyperlipidemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Familial Hyperlipidemia
Use these documentation templates to ensure complete and accurate documentation for Familial Hyperlipidemia. These templates include all required elements for proper coding and billing.
Confirmed Familial Hypercholesterolemia
Specialty: CardiologyRequired Elements
- Family history of premature CAD
- LDL-C levels
- Genetic test results
- Physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Familial Hyperlipidemia? Ask your questions below.