E78.011 — Heterozygous familial hypercholesterolemia [HeFH]
E78.011 is a billable, specific ICD-10-CM code for heterozygous familial hypercholesterolemia [hefh]. It is valid for submission on a claim.
Risk adjustment
E78.011 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
E78.011 is named in 25 Medicare coverage policies — 25 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A54543Therapeutic Apheresis for Familial Hypercholesterolemia
- A56289Billing and Coding: Therapeutic Apheresis for Familial Hypercholesterolemia
- A56416Billing and Coding: Assays for Vitamins and Metabolic Function
- A56422Billing and Coding: Bariatric Surgical Management of Morbid Obesity
How E78.011 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to E78.011.
- HeFH(heterozygous familial hypercholesterolemia)
- Cholesterolemia›familial›heterozygous
- Hypercholesterolemia›familial›heterozygous [HeFH]
Related codes at this level
Codes that share E78.01. If E78.011 is not quite right, the correct code is usually one of these.
Questions about E78.011
- Is E78.011 a billable ICD-10-CM code?
- Yes. E78.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E78.011 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Metabolic disorders (E70-E88).