What is ICD-10 code E78.00?

E78.00 is the ICD-10-CM diagnosis code for Pure hypercholesterolemia, unspecified. Elevated cholesterol levels in the blood with no specific cause identified, increasing the risk of heart disease and stroke. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E78.00 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E78.00 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E78.00 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E78.00 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E78.00 map to under V28?

E78.00 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

What does E78.00 pay in RAF?

E78.00 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for E78.00?

E78.00 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards E78.00 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Disorders of Fatty-Acid and Lipid Metabolism), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What documentation supports E78.00?

Verify whether the hypercholesterolemia is familial or acquired before coding Document LDL and total cholesterol levels when available for clinical context E78.00 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM E78.00: Pure hypercholesterolemia

E78.00 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software

ICD-10-CM Code View

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Code lookupE78.00Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)

E78.00

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Pure hypercholesterolemia, unspecified

Elevated cholesterol levels in the blood with no specific cause identified, increasing the risk of heart disease and stroke.

Buddy Insight

Pure hypercholesterolemia, unspecified represents elevated low-density lipoprotein (LDL) cholesterol without specification of whether it is familial or acquired.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 47

Disorders of Fatty-Acid and L...

Not separately weighted

Code Book Path

Official

E78Disorders of lipoprotein metabolism and other lipidemias

E78.0Pure hypercholesterolemia

E78.00Pure hypercholesterolemia, unspecified

Inclusion Terms

Official

Fredrickson's hyperlipoproteinemia, type IIa
Hyperbetalipoproteinemia
Low-density-lipoprotein-type [LDL] hyperlipoproteinemia
(Pure) hypercholesterolemia NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E78.00 in this effective period.

Related Child Codes

Official

E78.01Familial hypercholesterolemia

Includes

Official

ICD-10-CM does not list Includes notes for E78.00 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E78.00 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E78.00 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E78.00 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E78.00 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider assessment or diagnosis of pure hypercholesterolemia or elevated LDL cholesterol

Current lipid panel results with LDL cholesterol level

Whether familial or non-familial if known (determines more specific code)

Current treatment: statin therapy, other lipid-lowering agents, dietary modifications

MEAT Support

HCC Buddy guidance

Provider assessment or diagnosis of pure hypercholesterolemia or elevated LDL cholesterol

Current lipid panel results with LDL cholesterol level

Whether familial or non-familial if known (determines more specific code)

Current treatment: statin therapy, other lipid-lowering agents, dietary modifications

Audit Caution

HCC Buddy guidance

Using unspecified E78.00 when the provider documents familial hypercholesterolemia (should use E78.01)

Coding from lab results alone without a provider diagnosis or assessment of the lipid abnormality

Confusing pure hypercholesterolemia (LDL only) with mixed hyperlipidemia (LDL + triglycerides)

Not recognizing that this code does NOT carry HCC value in V24 or V28 — it is one of the most commonly coded conditions without RAF impact

Common Mistakes

HCC Buddy guidance

E78.01 — Familial hypercholesterolemia: use when familial/genetic form is confirmed; more specific and preferred

E78.2 — Mixed hyperlipidemia: use when both cholesterol AND triglycerides are elevated

E78.5 — Hyperlipidemia, unspecified: broader code when the type of lipid elevation is not documented

E78.41 — Elevated Lipoprotein(a): distinct lipid marker, not the same as LDL cholesterol elevation

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is E78.00 an HCC code?

E78.00 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Disorders of Fatty-Acid and Lipid Metabolism under the Part D RxHCC model.

Code: E78.00
Description: Pure hypercholesterolemia, unspecified
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 47, Disorders of Fatty-Acid and Lipid Metabolism

Not separately weighted

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work E78.00 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E78.00

For E78.00 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E78.00 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E78.00 is the ICD-10-CM diagnosis code for pure hypercholesterolemia, unspecified. Elevated cholesterol levels in the blood with no specific cause identified, increasing the risk of heart disease and stroke. E78.00 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

E78.00 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing E78.00 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E78.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify whether the hypercholesterolemia is familial or acquired before coding
•Document LDL and total cholesterol levels when available for clinical context

Clinical Significance

Pure hypercholesterolemia, unspecified represents elevated low-density lipoprotein (LDL) cholesterol without specification of whether it is familial or acquired. While extremely common in the general population, it is a major risk factor for atherosclerotic cardiovascular disease and requires documentation of ongoing management for risk adjustment purposes.

Documentation Requirements

✓Provider assessment or diagnosis of pure hypercholesterolemia or elevated LDL cholesterol
✓Current lipid panel results with LDL cholesterol level
✓Whether familial or non-familial if known (determines more specific code)
✓Current treatment: statin therapy, other lipid-lowering agents, dietary modifications
✓Treatment response and adherence assessment
✓Cardiovascular risk assessment

Commonly Confused Codes

•E78.01: Familial hypercholesterolemia: use when familial/genetic form is confirmed; more specific and preferred
•E78.2: Mixed hyperlipidemia: use when both cholesterol AND triglycerides are elevated
•E78.5: Hyperlipidemia, unspecified: broader code when the type of lipid elevation is not documented
•E78.41: Elevated Lipoprotein(a): distinct lipid marker, not the same as LDL cholesterol elevation
•E78.1: Pure hyperglyceridemia: elevated triglycerides only, not cholesterol

Child Codes

E78.00Pure hypercholesterolemia, unspecified

E78.01Familial hypercholesterolemia

Code Hierarchy

└E78Disorders of lipoprotein metabolism and other lipidemias └E78.0Pure hypercholesterolemia └E78.00Pure hypercholesterolemia, unspecified

└E78.00Pure hypercholesterolemia, unspecified

HCC Buddy Code Card

E78.00

Is E78.00 an HCC code?

HCC Category Mapping

MEAT Criteria for E78.00

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What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

E78.00 code history

Work E78.00 in HCC Buddy

E78.00 ICD-10-CM Code: Pure hypercholesterolemia, unspecified

HCC Buddy Code Card

E78.00

Is E78.00 an HCC code?

HCC Category Mapping

MEAT Criteria for E78.00

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

E78.00 code history

Work E78.00 in HCC Buddy