E78.01 ICD-10-CM Code: Familial hypercholesterolemia
HCC Buddy Code Card
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)
E78.01
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceFamilial hypercholesterolemia
Familial hypercholesterolemia
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 47
Not separately weighted
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E78.01 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E78.01 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E78.01 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E78.01 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E78.01 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E78.01 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E78.01 in this effective period.
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 E78.01 an HCC code?
E78.01 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
- E78.01
- Description
- Familial hypercholesterolemia
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- No
- Payment year
- 2026
HCC Category Mapping
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 E78.01 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E78.01
For E78.01 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 E78.01 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E78.01 is the ICD-10-CM diagnosis code for familial hypercholesterolemia. E78.01 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
Header codes like E78.01 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at E78.01's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E78.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.