What is ICD-10 code E78.70?

E78.70 is the ICD-10-CM diagnosis code for Disorder of bile acid and cholesterol metabolism, unspecified. A disorder affecting how the body processes bile acids and cholesterol, but the specific type is not identified. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E78.70 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E78.70 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. E78.70 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. E78.70 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 E78.70 map to under V28?

E78.70 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for E78.70?

E78.70 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for E78.70?

E78.70 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

What documentation supports E78.70?

This is an unspecified code; use only when the specific bile acid or cholesterol metabolism disorder cannot be determined Review genetic testing results or specialist documentation to assign a more specific E78.71, E78.72, or E78.79 code E78.70 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM E78.70: Disorder of bile acid and cholesterol

E78.70 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 lookupE78.70Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

E78.70

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

Disorder of bile acid and cholesterol metabolism, unspecified

A disorder affecting how the body processes bile acids and cholesterol, but the specific type is not identified.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

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 Lipoid Metabolism

Code-level coefficient reference

Code Book Path

Official

E78Disorders of lipoprotein metabolism and other lipidemias

E78.7Disorders of bile acid and cholesterol metabolism

E78.70Disorder of bile acid and cholesterol metabolism, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E78.70 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E78.70 in this effective period.

Related Child Codes

Official

E78.71Barth syndrome

E78.72Smith-Lemli-Opitz syndrome

E78.79Other disorders of bile acid and cholesterol metabolism

Includes

Official

ICD-10-CM does not list Includes notes for E78.70 in this effective period.

Excludes 1

Official

Niemann-Pick disease type C (E75.242)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E78.70 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E78.70 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E78.70 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of confirmed bile acid or cholesterol metabolism disorder

Diagnostic testing: serum bile acid profile, urine bile acid analysis, or genetic testing

Clinical manifestations: cholestatic jaundice, hepatomegaly, steatorrhea, fat-soluble vitamin deficiency

Reason for lack of specificity (workup in progress, indeterminate results)

MEAT Support

HCC Buddy guidance

Provider documentation of confirmed bile acid or cholesterol metabolism disorder

Diagnostic testing: serum bile acid profile, urine bile acid analysis, or genetic testing

Clinical manifestations: cholestatic jaundice, hepatomegaly, steatorrhea, fat-soluble vitamin deficiency

Reason for lack of specificity (workup in progress, indeterminate results)

Audit Caution

HCC Buddy guidance

Confusing bile acid metabolism disorders with biliary obstruction or cholelithiasis

Using this code for common cholesterol elevation (hypercholesterolemia) which has its own codes

Not recognizing that bile acid synthesis disorders may present as neonatal cholestasis and require metabolic workup

Failing to query for specificity when bile acid analysis results are available

Common Mistakes

HCC Buddy guidance

E78.79 — Other disorders of bile acid and cholesterol metabolism: use when a specific disorder is identified

K83.1 — Obstruction of bile duct: mechanical obstruction, not a metabolic disorder

E78.00 — Pure hypercholesterolemia: elevated circulating cholesterol, different from cholesterol metabolism pathway defects

E80.7 — Disorder of bilirubin metabolism, unspecified: bilirubin metabolism is separate from bile acid metabolism

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 E78.70 an HCC code?

E78.70 is not in the CMS-HCC V28 or V24 community payment model. E78.70 has a separate mapping under the Part D RxHCC model (HCC 47 (Disorders of Lipoid Metabolism)); the applicable result needs member context.

Code: E78.70
Description: Disorder of bile acid and cholesterol metabolism, unspecified
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 47, Disorders of Lipoid Metabolism

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work E78.70 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for E78.70

For E78.70 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 E78.70 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E78.70 is the ICD-10-CM diagnosis code for disorder of bile acid and cholesterol metabolism, unspecified. A disorder affecting how the body processes bile acids and cholesterol, but the specific type is not identified. E78.70 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

E78.70 has no mapping under the CMS-HCC V28 or V24 community payment models. E78.70 has a separate mapping under the Part D RxHCC model (HCC 47 (Disorders of Lipoid Metabolism)); the applicable result needs member context. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

This is an unspecified code; use only when the specific bile acid or cholesterol metabolism disorder cannot be determined.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E78.70 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is an unspecified code; use only when the specific bile acid or cholesterol metabolism disorder cannot be determined
•Review genetic testing results or specialist documentation to assign a more specific E78.71, E78.72, or E78.79 code

Clinical Significance

Disorder of bile acid and cholesterol metabolism, unspecified covers conditions where bile acid synthesis or cholesterol metabolic pathways are disrupted but the specific defect has not been identified. Bile acid synthesis disorders can cause cholestatic liver disease, fat malabsorption, and fat-soluble vitamin deficiency, often presenting in infancy or childhood.

Documentation Requirements

✓Provider documentation of confirmed bile acid or cholesterol metabolism disorder
✓Diagnostic testing: serum bile acid profile, urine bile acid analysis, or genetic testing
✓Clinical manifestations: cholestatic jaundice, hepatomegaly, steatorrhea, fat-soluble vitamin deficiency
✓Reason for lack of specificity (workup in progress, indeterminate results)
✓Treatment plan: bile acid replacement therapy (cholic acid), fat-soluble vitamin supplementation

Commonly Confused Codes

•E78.79: Other disorders of bile acid and cholesterol metabolism: use when a specific disorder is identified
•K83.1: Obstruction of bile duct: mechanical obstruction, not a metabolic disorder
•E78.00: Pure hypercholesterolemia: elevated circulating cholesterol, different from cholesterol metabolism pathway defects
•E80.7: Disorder of bilirubin metabolism, unspecified: bilirubin metabolism is separate from bile acid metabolism