ICD-10 Coding for Pure Hypercholesterolemia(E78.00, E78.01)
Complete ICD-10-CM coding and documentation guide for Pure Hypercholesterolemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pure Hypercholesterolemia
E78.0-E78.5Primary Range
Disorders of lipoprotein metabolism and other lipidemias
This range includes codes for various types of hyperlipidemia, including pure 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 LDL-C is elevated without familial patterns or secondary causes. |
|
| E78.01 | Familial hypercholesterolemia | Use when familial hypercholesterolemia is confirmed by genetic testing or family history. |
|
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 pure hypercholesterolemia
Essential facts and insights about Pure Hypercholesterolemia
Primary ICD-10-CM Codes for pure hypercholesterolemia
Decision Criteria
clinical Criteria
- LDL-C levels between 160-189 mg/dL without familial or secondary causes.
Applicable To
- Primary hypercholesterolemia
Excludes
- Familial hypercholesterolemia (E78.01)
Clinical Validation Requirements
- LDL-C 160-189 mg/dL
- No familial patterns
- Exclusion of secondary causes
Code-Specific Risks
- Risk of under-documentation if familial patterns are present.
Coding Notes
- Ensure documentation specifies 'pure' hypercholesterolemia to avoid unspecified coding.
E78.01 - Familial hypercholesterolemia
Use when familial hypercholesterolemia is confirmed by genetic testing or family history.
Applicable To
- Genetic hypercholesterolemia
Excludes
- Pure hypercholesterolemia, unspecified (E78.00)
Clinical Validation Requirements
- LDL-C ≥190 mg/dL
- Genetic testing confirming LDLR/APOB/PCSK9 variants
- Family history of premature CAD
Coding Notes
Ensure genetic testing results are documented to support familial coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pure 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: May lead to incorrect diagnosis coding., Regulatory: Non-compliance with coding standards., Financial: Potential reimbursement issues.
Mitigation Strategy
Always document family history for hypercholesterolemia cases.
Impact
Reimbursement: May affect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Confirm and document genetic testing or family history for E78.01.
Impact
Using unspecified codes when specific codes are applicable.
Mitigation Strategy
Ensure documentation supports the most specific code possible.
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 Pure Hypercholesterolemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pure Hypercholesterolemia
Use these documentation templates to ensure complete and accurate documentation for Pure Hypercholesterolemia. These templates include all required elements for proper coding and billing.
Primary Care Visit for Hypercholesterolemia
Specialty: Primary CareRequired Elements
- LDL-C levels
- Family history
- Secondary cause exclusion
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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