Hyperlipidemia ICD-10 – Overview
What is Hyperlipidemia?
Hyperlipidemia refers to excessive levels of lipids and fats in the blood and tissues. High cholesterol (excessive lipids) can be a significant risk factor for cardiovascular diseases, heart attacks, blocked arteries, and stroke.
Hyperlipidemia can either be primary (genetically defective metabolism) or secondary (due to other medical complications such as obesity, diabetes, hepatitis, liver disease, lupus, sleep apnea, chronic kidney disease, etc.)
Hyperlipidemia ICD-10 – What is Hyperlipidemia
Risk factors for hyperlipidemia:
Following are some factors that increase the risk of getting higher levels of lipids in the blood:
- Hypothyroidism
- History of hypercholesterolemia in the family
- Obesity
- Excessive consumption of saturated and trans fats
- Excessive alcohol consumption
- Smoking
- Diabetes
- Sedentary lifestyle
Complications of hyperlipidemia:
Hyperlipidemia can cause atherosclerosis (formation of plaques inside the blood vessels), thus blocking blood flow and rupturing the vessels in severe cases.
It can lead to:
- Coronary artery disease (CAD)
- Cardiac arrest
- Atherosclerosis
- Stroke or brain hemorrhage
- Carotid and peripheral artery diseases
- Cardiovascular and microvascular diseases
What is the ICD-10 coding system?
It is a coding system published by WHO. This system helps keep records of diseases, their diagnosis, procedures related to the treatment, and medical reimbursement in the healthcare system. Coding makes documentation easy and readily available.
What is ICD-10-CM?
ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a coding system used by healthcare providers in the United States to record and store the diagnosis, treatments, and services in the hospital setup.
Code structure: The first character is an alpha, the second and third must be numeric, and the fourth up to seven can be either alpha or numeric. The first three characters classify the disease, and the remaining characters provide other details about the injury.
Purpose of Hyperlipidemia ICD-10 coding
Below is the complete list of codes used in medical coding when a patient’s document states “Hyperlipidemia” or “high cholesterol,” etc.
The unspecified code for hyperlipidemia (E78.5) is used when the reason or type of disease is not present.
Other-specified (E78.49) diagnosis codes are used when the specific code for the hyperlipidemia condition is absent.
With few Diagnosis codes, there is an exclusive criterion, meaning that the default diagnosis codes can not bill with that excluded code.
E78.0- Hypercholesterolemia
Same code for below other related conditions:
- Pure hypercholesterolemia (group A)
- Hyperlipidemia (group A)
- Hyperlipoproteinemia, type IIa (Fredrickson classification)
- LDL type hyperlipoproteinemia
- Hyperbetalipoproteinemia (elevated levels of beta lipoproteins and cholesterol)
E78.00- Unspecified hypercholesterolemia (pure)
E78.01- Familial hypercholesterolemia
E78.1- Pure hyperglyceridemia
Same code for below other related conditions:
- Endogenous hyperglyceridemia (increased VLDL-triglycerides in the blood due to increased production of VLDL from the liver)
- Hyperlipidemia (group B)
- VLDL type hyperlipoproteinemia
- Hyperlipoproteinemia, type IV (Fredrickson classification)
- Hyperprebetalipoproteinemia
Exclude:
- Cerebrotendinous Cholestrosis (Van Baggert-Scherer-Epstein)
E78.2- Mixed hyperlipidemia
Same code for below other related conditions:
- Hyperlipidemia (group C)
- Hypercholesterolemia with hyperglyceridemia
- Floating abetalipoproteinemia
- Hyperlipoproteinemia, type IIb and type III
- Hyperbetalipoproteinemia with abetalipoproteinemia
- Tuberoeruptive xanthoma
E78.3- Hyperchylomicronemia
Same code for below other related conditions:
- Mixed hyperglyceridemia
- Hyperlipidemia (group D)
- Hyperlipoproteinemia type I and type V (Frederickson classification)
E78.4- Other hyperlipidemia
E78.41- Elevated lipoprotein A (lipoprotein (a) is a variant of LDL. It is responsible for atherogenesis and atherosclerosis. Hence elevated levels lead to plaque formation and increase the risk of heart attack).
E78.49- Other hyperlipidemia
E78.5- Unspecified hyperlipidemia
E78.6- Lipoprotein Deficiency
- Abetalipoproteinemia (absence of lipoproteins including LDLs, VLDLs, and chylomicrons in the blood because of mutations in a gene “MTTP” (Microsomal Triglycerides Transfer Protein.)) This gene produces an enzyme MTP that is responsible for the secretion of apo B. ApoB works for proper absorption and transfer of fats throughout the body. Hence, the absence of ApoB leads to a deficiency of lipoproteins mentioned above.
- HDL deficiency
- Familial hypobetalipoproteinemia
- Hypoalphalipoproteinemia
- Tangier disease
E78.7- Disorders of cholesterol metabolism and bile acid
Exclude:
Niemann-Pick disease type C (E75.242)
E78.70- Unspecified bile and cholesterol metabolism disorders
E78.71- Barth syndrome (lipid metabolism disorder due to decreased production of an enzyme, “cardiolipin,” which is responsible for energy metabolism).
E78.72- Smith Lemli Opitz Syndrome (a developmental disorder due to the mutated DHCR7 gene responsible for producing 7-dehydrocholesterol reductase enzyme. This enzyme finalizes the production of cholesterol. Cholesterol is vital for normal embryonic development. A mutation in the DHCR7 gene inhibits the formation of cholesterol).
E78.79- Other disorders of bile acid and cholesterol metabolism.
E78.8- Other disorders of lipoprotein metabolism
E78.81- Lipid dermatoarthritis (lipid metabolism disorder that resembles rheumatoid arthritis and is associated with cutaneous nodules and polyarthritis).
E78.89- Other lipoprotein metabolism disorders
E78.9- Unspecified lipoprotein metabolism disorders
Types of Hyperlipidemia:
According to the “Frederickson” classification, the following are the types of hyperlipidemia:
Type I:
a. Familial Hyperchylomicronemia:
It is an autosomal recessive disorder that occurs due to a decrease in the lipoprotein lipase (LPL) enzyme. It leads to the inflammation of the pancreas, eruptive skin with deposition of cholesterol (xanthomas), and an enlarged liver and spleen. It is a rare condition; diet control is essential to manage the symptoms.
b. Apolipoprotein C-II deficiency (familial apoprotein C-II deficiency):
The cause of this type is a defective or altered apoprotein C-II. The symptoms are the same as familial hyperchylomicronemia.
c. Cyclomicronemia due to lipoprotein lipase inhibitor:
The circulating lipoprotein lipase inhibitor in the blood causes an increase in chylomicrons. Symptoms are as same as the above two subtypes of type 1 hyperlipidemia.
Type II:
a. Familial hypercholesterolemia:
It is an autosomal dominant disorder. It is characterized by xanthelasmas (cutaneous plaques on eyelids) and xanthomas on the tendons (particularly on the Achilles tendon). It happens because of the deficiency of low-density lipoprotein (LDL) receptors, which increases the blood’s LDL (bad cholesterol).
b. Familial combined hyperlipidemia:
It is characterized by elevated levels of low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL) in the blood. Along with the decreased LDL receptors, there is an elevated level of ApoB (Apolipoprotein B acts as a ligand for LDL receptors).
Type III:
Familial dysbetalipoproteinemia:
It is characterized by an increased level of Intermediate-density lipoproteins (IDLs) in the blood. These lipoproteins are the degraded remnants of LDLs, HDLs, and VLDLs. This accumulation happens due to a mutation in the APO E gene, which fails to produce the apolipoprotein E enzyme responsible for fat metabolism. It leads to defective hepatic clearance and hence the accumulation of cholesterol (xanthomas), especially in palms.
Type IV:
Familial hypertriglyceridemia:
This type of hyperlipidemia is associated with increased production and decreased elimination of very low-density lipoproteins (VLDL).
As a result, the triglyceride levels markedly increase and can lead to pancreatitis.
Type V:
Familial mixed hypertriglyceridemia:
It takes its name from type I and type IV of hyperlipidemia ( hence termed “mixed”). It is characterized by an increased level of chylomicrons as well as VLDLs. Decreased Lipoprotein lipase (LPL) (which is responsible for the hydrolysis of triglycerides and VLDL) is the main culprit behind this disorder.
Tips for ICD-10 coding for hyperlipidemia:
When the patient’s medical record states any of the above types of hyperlipidemia or hypercholesteremia, choose the diagnosis code carefully from the abovementioned codes in the article. If the diagnosis code doesn’t match the above codes, always use other specified or unspecified Dx.
References:
1. JeremyStewart,MD, TracyMcCallin,MD, JulianMartinez, SheebuChacko, MD, ShabanaYusuf,MD,MEd; Hyperlipidemia; Pediatrics In Review; Vol 41; 2020.
2. ICD 10 Version: 2019; World Health Organisation
3. https://icd.who.int/browse10/2019/en#E75.0
4. Rajeev Rajagopal; What Are the ICD-10 Codes for Hyperlipidemia? ; Outsource Strategies International; 2022.
5. Rami A. Ballout, Alan T. Remaley; Pediatric dyslipidemias: lipoprotein metabolism disorders in children; Biochemical and Molecular Basis of Pediatric Disease (Fifth Edition); 2021.
https://www.sciencedirect.com/topics/medicine-and-dentistry/type-1-hyperlipidemia
6. Kazuhisa Tsukamoto; Endogenous hypertriglyceridemia; Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University; 2013.
https://pubmed.ncbi.nlm.nih.gov/
7. Tayla Holman, Scott Wallask Kristen Lee; ICD-10 (International Classification of Diseases, Tenth Revision); IT Health; 2018.
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