Effective October 2025, ICD-10-CM code E78.01 (Familial hypercholesterolemia) has been deleted and replaced with new, more specific codes.
New Codes:
- E78.010 – Homozygous familial hypercholesterolemia (HoFH)
- E78.011 – Heterozygous familial hypercholesterolemia (HeFH)
- E78.019 – Familial hypercholesterolemia, unspecified
What You Need to Know:
- E78.010 is for patients with the most severe form (HoFH), inherited from both parents.
- E78.011 is for the more common, less severe form (HeFH), inherited from one parent.
- E78.019 should only be used if the specific type is not documented.
Why This Matters:
- Improved Patient Care: Accurate coding ensures patients receive the most appropriate management and treatment for their specific type of FH.
- Accurate Billing & Reimbursement: Insurance payers require the most specific code. Using unspecified codes when a specific one is available can lead to claim denials, payment delays, or lower reimbursement.
- Enhanced Data Quality: Specific codes improve research, public health tracking, and quality reporting.
- Documentation Best Practice: Always use the highest level of specificity supported by the medical record. Use E78.019 only as a last resort.
Action Steps for Providers:
- Review and update patient charts to reflect the appropriate specific code.
- Ensure all medical documentation supports the correct diagnosis and code.
- Check payer requirements for authorizations, as new codes may require updated approvals.
This update is part of the annual ICD-10-CM guidelines and aims to improve the accuracy of patient diagnosis, billing, and research data. Please update your records and workflows accordingly.