ICD-10 Coding for Hypercholesterolemia(E78.00, E78.01, E78.2)
Complete ICD-10-CM coding and documentation guide for Hypercholesterolemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypercholesterolemia
E78.0-E78.5Primary Range
Disorders of lipoprotein metabolism and other lipidemias
This range includes codes for various types of hyperlipidemia, including 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 |
|---|---|---|---|
| E78.00 | Pure hypercholesterolemia, unspecified | Use when elevated cholesterol is present without a specific cause or genetic confirmation. |
|
| E78.01 | Familial hypercholesterolemia | Use when genetic testing confirms familial hypercholesterolemia. |
|
| E78.2 | Mixed hyperlipidemia | Use when both cholesterol and triglycerides are elevated. |
|
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 hypercholesterolemia
Essential facts and insights about Hypercholesterolemia
Primary ICD-10-CM Codes for hypercholesteremia
Decision Criteria
clinical Criteria
- LDL ≥190 mg/dL with no secondary causes
documentation Criteria
- Document specific LDL levels and absence of secondary causes
Applicable To
- Elevated LDL cholesterol without specific cause
Clinical Validation Requirements
- LDL ≥190 mg/dL in adults
- No triglycerides >200 mg/dL
Code-Specific Risks
- Misclassification when familial hypercholesterolemia is suspected
Coding Notes
- Ensure LDL levels are documented and secondary causes are ruled out.
E78.01 - Familial hypercholesterolemia
Use when genetic testing confirms familial hypercholesterolemia.
Applicable To
- Genetically confirmed hypercholesterolemia
Excludes
- Pure hypercholesterolemia (E78.00)
- Mixed hyperlipidemia (E78.2)
Clinical Validation Requirements
- LDL ≥190 mg/dL
- Genetic testing confirming LDLR, APOB, or PCSK9 mutation
Coding Notes
Document genetic test results and family history.
E78.2 - Mixed hyperlipidemia
Use when both cholesterol and triglycerides are elevated.
Applicable To
- Elevated cholesterol and triglycerides
Excludes
- Pure hypercholesterolemia (E78.00)
- Familial hypercholesterolemia (E78.01)
Clinical Validation Requirements
- LDL ≥160 mg/dL
- Triglycerides ≥150 mg/dL
Coding Notes
Ensure both cholesterol and triglyceride levels are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long term (current) use of insulin
Z79.4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypercholesterolemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E78.00.
Impact
Clinical: Potential misdiagnosis of familial hypercholesterolemia., Regulatory: Non-compliance with coding standards., Financial: Possible claim denials or reduced reimbursement.
Mitigation Strategy
Ensure genetic testing is ordered and results are documented., Review family history for early heart disease.
Impact
Reimbursement: Incorrect coding can lead to denied claims or lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Ensure genetic testing or clinical criteria are documented for E78.01.
Impact
Using unspecified codes like E78.5 when specific codes are applicable.
Mitigation Strategy
Ensure specific lab results and clinical criteria are documented.
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 Hypercholesterolemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypercholesterolemia
Use these documentation templates to ensure complete and accurate documentation for Hypercholesterolemia. These templates include all required elements for proper coding and billing.
Primary care visit for hypercholesterolemia management
Specialty: Primary CareRequired Elements
- Patient history
- Family history
- Lab results
- Physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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