What is ICD-10 code E78.1?

E78.1 is the ICD-10-CM diagnosis code for Pure hyperglyceridemia. Elevated triglycerides (a type of fat) in the blood without significantly elevated cholesterol, which can increase heart disease risk. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E78.1 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E78.1 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. E78.1 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. E78.1 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 E78.1 map to under V28?

E78.1 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 E78.1 pay in RAF?

E78.1 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 E78.1?

E78.1 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 E78.1 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 E78.1?

Document triglyceride levels and whether this is primary or secondary to other conditions Distinguish from mixed hyperlipidemia where both cholesterol and triglycerides are elevated E78.1 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 E78.1: Pure hyperglyceridemia

E78.1 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

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

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

E78.1

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

Pure hyperglyceridemia

Elevated triglycerides (a type of fat) in the blood without significantly elevated cholesterol, which can increase heart disease risk.

Buddy Insight

Pure hyperglyceridemia (hypertriglyceridemia) involves elevated triglyceride levels without significant cholesterol elevation.

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

E78.1Pure hyperglyceridemia

Inclusion Terms

Official

Elevated fasting triglycerides
Endogenous hyperglyceridemia
Fredrickson's hyperlipoproteinemia, type IV
Hyperlipidemia, group B
Hyperprebetalipoproteinemia

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E78.1 in this effective period.

Related Child Codes

Official

E78.0Pure hypercholesterolemia

E78.2Mixed hyperlipidemia

E78.3Hyperchylomicronemia

E78.4Other hyperlipidemia

E78.5Hyperlipidemia, unspecified

Includes

Official

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

Excludes 1

Official

sphingolipidosis (E75.0-E75.3)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E78.1 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E78.1 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E78.1 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider diagnosis of hypertriglyceridemia or pure hyperglyceridemia

Current triglyceride level from lipid panel

Severity classification: mild (150-199), moderate (200-499), severe (500-999), very severe (1000+) mg/dL

Underlying etiology if known (familial, secondary to diabetes, obesity, medications, alcohol)

MEAT Support

HCC Buddy guidance

Provider diagnosis of hypertriglyceridemia or pure hyperglyceridemia

Current triglyceride level from lipid panel

Severity classification: mild (150-199), moderate (200-499), severe (500-999), very severe (1000+) mg/dL

Underlying etiology if known (familial, secondary to diabetes, obesity, medications, alcohol)

Audit Caution

HCC Buddy guidance

Using E78.1 when both cholesterol and triglycerides are elevated (should be E78.2 mixed hyperlipidemia)

Not differentiating primary (familial) from secondary hypertriglyceridemia for treatment planning

Coding from lab values alone without provider assessment or diagnosis

Failing to recognize that very high triglycerides may also warrant coding for pancreatitis risk or related complications

Common Mistakes

HCC Buddy guidance

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

E78.3 — Hyperchylomicronemia: specific condition with chylomicron persistence, often with very high triglycerides

E78.00 — Pure hypercholesterolemia, unspecified: elevated cholesterol only, not triglycerides

E78.5 — Hyperlipidemia, unspecified: too broad when the specific lipid type is documented

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 E78.1 an HCC code?

E78.1 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: E78.1
Description: Pure hyperglyceridemia
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 E78.1 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E78.1

For E78.1 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 E78.1 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E78.1 is the ICD-10-CM diagnosis code for pure hyperglyceridemia. Elevated triglycerides (a type of fat) in the blood without significantly elevated cholesterol, which can increase heart disease risk. E78.1 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

E78.1 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 E78.1 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 E78.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document triglyceride levels and whether this is primary or secondary to other conditions
•Distinguish from mixed hyperlipidemia where both cholesterol and triglycerides are elevated

Clinical Significance

Pure hyperglyceridemia (hypertriglyceridemia) involves elevated triglyceride levels without significant cholesterol elevation. While moderate elevations increase cardiovascular risk, severely elevated triglycerides (above 500 mg/dL) carry a significant risk of acute pancreatitis, requiring urgent management and close monitoring.

Documentation Requirements

✓Provider diagnosis of hypertriglyceridemia or pure hyperglyceridemia
✓Current triglyceride level from lipid panel
✓Severity classification: mild (150-199), moderate (200-499), severe (500-999), very severe (1000+) mg/dL
✓Underlying etiology if known (familial, secondary to diabetes, obesity, medications, alcohol)
✓Treatment plan: fibrates, omega-3 fatty acids, lifestyle modifications, or combination therapy
✓Assessment for pancreatitis risk if triglycerides are severely elevated

Commonly Confused Codes

•E78.2: Mixed hyperlipidemia: use when BOTH triglycerides AND cholesterol are elevated
•E78.3: Hyperchylomicronemia: specific condition with chylomicron persistence, often with very high triglycerides
•E78.00: Pure hypercholesterolemia, unspecified: elevated cholesterol only, not triglycerides
•E78.5: Hyperlipidemia, unspecified: too broad when the specific lipid type is documented
•E78.49: Other hyperlipidemia: for lipid elevations not classified elsewhere