ICD-10-CM · Endocrine, nutritional, metabolic
ICD-10-CM · Endocrine, nutritional, metabolicE78.019: Familial hypercholesterolemia, unspecified
E78.019 is the ICD-10-CM code for Familial hypercholesterolemia, unspecified. Billable on U.S. claims with supporting documentation. Chapter: Endocrine, nutritional, metabolic. Category: E78.
About this code
Familial hypercholesterolemia, unspecified.
E78.019 is an ICD-10-CM diagnosis code for familial hypercholesterolemia, unspecified. It sits in the 4. Endocrine, nutritional, metabolic chapter of the U.S. clinical modification, under category E78.
This code is billable on U.S. healthcare claims when supported by appropriate clinical documentation. The patient chart must establish the diagnosis, capture any clinical detail encoded in the code (severity, laterality, encounter type, complications where applicable), and demonstrate medical necessity for the billed services.
Payer-specific coverage rules vary. Always cross-check against the current Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for the payer adjudicating the claim, plus any specialty-specific CMS Medicare Administrative Contractor guidance.
Billing context
What practitioners watch for on E78.019.
Chapter-level billing guidance for endocrine, nutritional, metabolic codes. Code-specific notes ship as the dataset matures.
Documentation
Document the disorder specifically (type 1 vs type 2 diabetes, controlled vs uncontrolled), associated complications (neuropathy, nephropathy, retinopathy), and current treatment (insulin status). The "with" convention in ICD-10-CM links manifestations to the underlying condition.
Common denial categories
- CO-16: Information missing or incorrect on the claim or in supporting documentation. Add documentation specificity that supports the coded detail; resubmit with corrected information.
- CO-50: Service not deemed medically necessary by the payer. Confirm the diagnosis-procedure relationship matches LCD/NCD coverage, attach clinical justification, appeal with documentation.
- CO-11: Diagnosis is inconsistent with the procedure performed. Verify the diagnosis-to-procedure pairing per payer policy; correct the linked diagnosis pointer or the procedure code.
Coverage signal
Endocrine coverage is generally broad. Type 2 diabetes (E11) codes follow the "with" convention: a manifestation listed under the parent E11 code is presumed related unless documented otherwise.
Common specialties
Endocrinology · Family Medicine · Internal Medicine
Companion CPT codes
Procedures commonly billed alongside E78.019 based on Medonix client production data and CMS coding guidance.
- 83036Hemoglobin A1c
- 80061Lipid panel
- 99213Office visit, established, low complexity
- 99214Office visit, established, moderate complexity
- G0108Diabetes self-management training, individual
CPT is a registered trademark of the American Medical Association. Codes shown for educational reference only.
Related codes
Other codes in category E78.
- E78.00
Pure hypercholesterolemia, unspecified
Open - E78.010
Homozygous familial hypercholesterolemia [HoFH]
Open - E78.011
Heterozygous familial hypercholesterolemia [HeFH]
Open - E78.1
Pure hyperglyceridemia
Open - E78.2
Mixed hyperlipidemia
Open - E78.3
Hyperchylomicronemia
Open - E78.41
Elevated Lipoprotein(a)
Open - E78.49
Other hyperlipidemia
Open
Sources
Where this entry comes from.
- NLM Clinical Tables Search Service: the official U.S. National Library of Medicine API for ICD-10-CM lookup.
- CDC National Center for Health Statistics: annual ICD-10-CM Tabular List release with effective date October 1.
- CMS Medicare Coverage Database: Local Coverage Determinations and National Coverage Determinations for payer-specific rules.
Frequently asked
About ICD-10 code E78.019.
Talk to RCM
Ready to recover every dollar your practice earns?
See your projected revenue lift in 60 seconds, or talk to a senior RCM strategist now. No commitment. Same-day slots available.
- 30-day parallel-run guarantee
- Targets written into the contract
- HIPAA · SOC 2 Type II · HITRUST