ICD-10 Coding for Lipidemia(E78.0, E78.1, E78.2, E78.5)
Complete ICD-10-CM coding and documentation guide for Lipidemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lipidemia
E78.0-E78.5Primary Range
Disorders of lipoprotein metabolism and other lipidemias
This range includes various types of hyperlipidemia, which are common conditions associated with elevated lipid levels in the blood.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E78.0 | Pure hypercholesterolemia | Use when LDL cholesterol is ≥190 mg/dL without elevated triglycerides. |
|
| E78.1 | Pure hypertriglyceridemia | Use when triglycerides are ≥500 mg/dL with normal LDL/HDL levels. |
|
| E78.2 | Mixed hyperlipidemia | Use when both LDL and triglycerides are elevated. |
|
| E78.5 | Unspecified hyperlipidemia | Use when specific lipid levels are not 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 lipidemia
Essential facts and insights about Lipidemia
Primary ICD-10-CM Codes for lipidemia
Decision Criteria
clinical Criteria
- LDL cholesterol level ≥190 mg/dL
Applicable To
- Familial hypercholesterolemia
Excludes
- Mixed hyperlipidemia (E78.2)
Clinical Validation Requirements
- LDL ≥190 mg/dL
Code-Specific Risks
- Incorrectly coding when triglycerides are also elevated.
Coding Notes
- Ensure LDL levels are documented to support this code.
E78.1 - Pure hypertriglyceridemia
Use when triglycerides are ≥500 mg/dL with normal LDL/HDL levels.
Applicable To
- Hypertriglyceridemia
Excludes
- Mixed hyperlipidemia (E78.2)
Clinical Validation Requirements
- Triglycerides ≥500 mg/dL
Coding Notes
Document triglyceride levels to validate coding.
E78.2 - Mixed hyperlipidemia
Use when both LDL and triglycerides are elevated.
Applicable To
- Combined hyperlipidemia
Excludes
- Pure hypercholesterolemia (E78.0)
Clinical Validation Requirements
- LDL ≥160 mg/dL and Triglycerides ≥200 mg/dL
Coding Notes
Ensure both LDL and triglyceride levels are documented.
E78.5 - Unspecified hyperlipidemia
Use when specific lipid levels are not documented.
Applicable To
- Hyperlipidemia NOS
Excludes
- Specific types of hyperlipidemia (E78.0-E78.4)
Clinical Validation Requirements
- Incomplete lipid profile documentation
Coding Notes
Avoid use if specific lipid levels can be documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Lipidemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E78.0.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure lipid panel results are included in every relevant patient visit., Train staff on importance of complete documentation.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Confirm both LDL and triglycerides meet thresholds before coding.
Impact
Reimbursement: Potential for claim rejections., Compliance: Increased audit risk., Data Quality: Loss of specificity in patient records.
Mitigation Strategy
Query provider for specific hyperlipidemia type.
Impact
High audit risk if E78.5 is used without supporting documentation.
Mitigation Strategy
Ensure specific lipid levels 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 Lipidemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lipidemia
Use these documentation templates to ensure complete and accurate documentation for Lipidemia. These templates include all required elements for proper coding and billing.
Primary Care Visit for Lipidemia
Specialty: Family MedicineRequired Elements
- Patient history
- Family history of cardiovascular disease
- Physical examination findings
- Lipid panel results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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