ICD-10 Coding for Hyperlipidemia(E78.0, E78.1, E78.2)
Complete ICD-10-CM coding and documentation guide for Hyperlipidemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hyperlipidemia
E78.0-E78.5Primary Range
Disorders of lipoprotein metabolism and other lipidemias
This range includes all primary codes for hyperlipidemia, covering various types of lipid disorders.
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 elevated above 190 mg/dL with familial pattern confirmed. |
|
| E78.1 | Pure hyperglyceridemia | Use when triglycerides are significantly elevated, posing a risk for pancreatitis. |
|
| E78.2 | Mixed hyperlipidemia | Use when both LDL 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 hyperlipidemia
Essential facts and insights about Hyperlipidemia
Primary ICD-10-CM Codes for hyperlipidemia
Decision Criteria
clinical Criteria
- LDL cholesterol levels above 190 mg/dL
Applicable To
- Familial hypercholesterolemia
Excludes
- Hyperlipidemia, unspecified (E78.5)
Clinical Validation Requirements
- LDL > 190 mg/dL
- Genetic test results confirming familial pattern
Code-Specific Risks
- Misclassification if genetic testing is not documented
Coding Notes
- Ensure documentation of genetic testing for familial cases.
E78.1 - Pure hyperglyceridemia
Use when triglycerides are significantly elevated, posing a risk for pancreatitis.
Applicable To
- Severe hypertriglyceridemia
Excludes
- Mixed hyperlipidemia (E78.2)
Clinical Validation Requirements
- Triglycerides > 500 mg/dL
- Risk of pancreatitis documented
Coding Notes
Document triglyceride levels and risk factors for pancreatitis.
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
- Triglycerides > 150 mg/dL
Coding Notes
Ensure both LDL 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
Z79.4Type 2 diabetes mellitus with other specified complication
E11.69Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.10Differential 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 Hyperlipidemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E78.0.
Impact
Clinical: Incomplete risk assessment., Regulatory: Potential non-compliance with coding standards., Financial: May affect reimbursement if familial hyperlipidemia is not documented.
Mitigation Strategy
Always ask about family history during patient intake.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify both LDL and triglycerides are elevated before using E78.2.
Impact
Using E78.5 without proper justification.
Mitigation Strategy
Ensure specific lipid abnormalities 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 Hyperlipidemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hyperlipidemia
Use these documentation templates to ensure complete and accurate documentation for Hyperlipidemia. These templates include all required elements for proper coding and billing.
Hyperlipidemia management in primary care
Specialty: Primary CareRequired Elements
- Lipid panel results
- Family history
- Current medications
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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