E78.019 ICD-10-CM Code: Familial hypercholesterolemia, unspecified
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)
E78.019
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFamilial hypercholesterolemia, unspecified
An inherited condition causing high cholesterol levels, but the specific type (whether from one or both parents) has not been determined.
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
Official- Familial hypercholesterolemia NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E78.019 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E78.019 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E78.019 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E78.019 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E78.019 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E78.019 in this effective period.
Buddy Documentation Tip
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 E78.019 an HCC code?
E78.019 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
- E78.019
- Description
- Familial hypercholesterolemia, unspecified
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- 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 E78.019 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E78.019
For E78.019 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 E78.019 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E78.019 is the ICD-10-CM diagnosis code for familial hypercholesterolemia, unspecified. An inherited condition causing high cholesterol levels, but the specific type (whether from one or both parents) has not been determined. E78.019 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
E78.019 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.
Use only when the specific inheritance pattern cannot be determined.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E78.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when the specific inheritance pattern cannot be determined
- •Query provider for genetic testing results or family history to specify homozygous vs. heterozygous