E78.72 — Smith-Lemli-Opitz syndrome
E78.72 is a billable, specific ICD-10-CM code for smith-lemli-opitz syndrome. It is valid for submission on a claim.
Other codes that can never be billed with E78.72
These codes carry an Excludes1 note pointing at E78.72. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E78.72 alone.
- Q87.1Congenital malformation syndromes predominantly associated with short stature
Risk adjustment
E78.72 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
E78.72 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
- A57071Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
How E78.72 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 E78.72.
- Smith-Lemli-Opitz syndrome
- Disorder›bile acid and cholesterol metabolism›Smith-Lemli-Opitz syndrome
- Disorder›cholesterol and bile acid metabolism›Smith-Lemli-Opitz syndrome
Related codes at this level
Codes that share E78.7. If E78.72 is not quite right, the correct code is usually one of these.
Questions about E78.72
- Is E78.72 a billable ICD-10-CM code?
- Yes. E78.72 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E78.72 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Metabolic disorders (E70-E88).