Hypercholesterolemia ICD-10 Coding: When to Assign E78.0 vs Other Lipid Disorder Codes 

Understanding Hypercholesterolemia in ICD-10-CM Coding 

Hypercholesterolemia refers specifically to elevated cholesterol levels, most commonly elevated LDL cholesterol. In ICD-10-CM, it falls under category E78.- Disorders of lipoprotein metabolism and other lipidemias. 

It is important for coders to distinguish hypercholesterolemia from broader lipid disorders, as code selection depends on the type of lipid abnormality documented. 

ICD-10-CM Code Assignment for Hypercholesterolemia 

When documented, hypercholesterolemia is reported with: 

E78.0 – Pure hypercholesterolemia 

Subclassification includes: 

• E78.00 – Pure hypercholesterolemia, unspecified 
• E78.01 – Familial hypercholesterolemia 

Use subcategory E78.01- when documentation clearly identifies a genetic or familial condition. Otherwise, assign E78.00 when no further specificity is provided. 

Differentiating Hypercholesterolemia from Other Lipid Disorders 

Accurate code selection requires understanding how hypercholesterolemia differs from other lipid conditions: 

• E78.0- → Cholesterol only (pure hypercholesterolemia) 
• E78.1 → Elevated triglycerides (hyperglyceridemia) 
• E78.2 → Mixed hyperlipidemia (cholesterol + triglycerides) 
• E78.5 → Hyperlipidemia, unspecified 

Do not assign E78.0- if documentation supports mixed or combined lipid abnormalities. 

Coding Tips for Accurate Assignment 

• Code the condition as documented by the provider, not based on lab values alone. 
• Do not assume hypercholesterolemia from elevated LDL unless explicitly documented. 
• Avoid defaulting to E78.5 (unspecified hyperlipidemia) when documentation supports a more specific diagnosis. 

Review the record for: 

• Problem list documentation 
• Assessment/plan statements 
• History of familial lipid disorders 

Common Coding Pitfalls 

• Assigning E78.00 when documentation only states “hyperlipidemia”.
• Using unspecified codes when the provider has documented a specific lipid abnormality elsewhere in the record.
• Coding based solely on lab findings without provider confirmation.
• Failing to identify familial hypercholesterolemia (E78.01-) when documented. 

FY 2026 Coding Considerations 

Code E78.01, Familial hypercholesterolemia was expanded: 

• E78.010 - Homozygous familial hypercholesterolemia (HoFH) 
• E78.011-Heterozygous familial hypercholesterolemia (HeFH) 
• E78.019 - Familial hypercholesterolemia, unspecified 

Heterozygous familial hypercholesterolemia (HeFH) occurs when an individual inherits the variant (mutated) gene from one parent. HeFH is the most common type and can be defined as LDL-C levels above 190 mg/dL. Homozygous familial hypercholesterolemia (HoFH) occurs when an individual inherits the variant gene from both parents. HoFH is the most severe type, and if untreated, could result in LDL-C levels above 400 Mg/dL. 

Coding expectations remain consistent: 

• Assign the most specific code available 
• Follow provider documentation 
• Ensure correct differentiation between lipid disorder types 

Lori Amende, RHIA, CCS 

Education and Quality Manager at UASI

Works Cited 

Centers for Medicare & Medicaid Services. (2025). ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026. 

National Heart, Lung, and Blood Institute. (2023). High blood cholesterol. Available at: https://www.nhlbi.nih.gov 

National Library of Medicine. (2024). High blood cholesterol (hypercholesterolemia). MedlinePlus Medical Encyclopedia. Available at: https://medlineplus.gov/ency/article/000403.htm