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E78.5ICD-10-CM

Hyperlipidemia, unspecified

BillableNo inclusion termsTwo unspecified codes in one category

How the code is built

E

Chapter

Endocrine, nutritional and metabolic diseases

78

Category

Disorders of lipoprotein metabolism and other lipidemias

5

Char 4

Hyperlipidemia, type not specified

Chapter

E00 to E89

Endocrine, nutritional and metabolic diseases

Block

E70 to E88

Metabolic disorders

Category

E78

Disorders of lipoprotein metabolism and other lipidemias

Billable

Yes

Complete at 4 characters

Inclusion terms

None

The code line carries no Applicable To entries

Excludes1 at E78

Sphingolipidosis (E75.0 to E75.3)

The only exclusion in the category

DefinitionCode structureClinical pictureDocumentationDecision guideTabular listComparisonClaim contextDenialsSources

Key takeaways

  • E78.5 codes hyperlipidemia when the record does not say which lipid fraction is elevated
  • Dyslipidemia and hyperlipoproteinemia both index to this code, which is why it appears so often
  • The code carries no inclusion terms, so nothing in the tabular list expands what it covers
  • E78.9 is a second unspecified code in the same category, and it means something different
  • It is billable, and the lipid panel that prompted it usually contains the specificity it lacks
1Definition

What ICD-10 code E78.5 means

E78.5 is the ICD-10-CM code for hyperlipidemia, unspecified. It applies when a provider documents elevated blood lipids without identifying which fraction is abnormal, meaning the record does not distinguish high cholesterol from high triglycerides or both together.

The Alphabetic Index routes several very common terms here, including dyslipidemia, hyperlipidemia, hyperlipoproteinemia, and lipoproteinemia. That routing explains the code's volume. A provider writing dyslipidemia in an assessment has written the phrase the index sends straight to E78.5.

Code

E78.5

Descriptor

Hyperlipidemia, unspecified

Chapter

Endocrine, nutritional and metabolic diseases

Block

Metabolic disorders

Category

E78, disorders of lipoprotein metabolism and other lipidemias

Billable

Yes

Inclusion terms

None at the code line

Excludes1

Sphingolipidosis (E75.0 to E75.3), inherited from the category

The descriptor has not changed in any fiscal year since 2015. What makes this code different from most unspecified codes is where the missing specificity lives. On a dementia or anemia page, the cause requires a workup that may never happen. Here, the lipid panel that generated the diagnosis is already in the chart, and it names the elevated fraction in numbers.

2Code structure

Which fraction, and two different kinds of unspecified

E78.5 has no subdivisions. Two structural facts decide whether it is correct, and the second one is unusual.

The fraction axis, which the lipid panel already answers

Fraction not stated

E78.5

This code

Cholesterol elevated alone

E78.0-

Familial hypercholesterolemia

E78.01-, which requires a sixth character

Triglycerides elevated alone

E78.1

Cholesterol and triglycerides both elevated

E78.2

Chylomicrons elevated

E78.3

Lipoprotein(a) elevated

E78.41

Familial combined hyperlipidemia

E78.49

Two unspecified codes, which are not interchangeable

E78.5

Lipids are elevated, but the fraction is unknown

E78.9

A lipoprotein metabolism disorder exists, without saying it is elevated at all.

That distinction is easy to miss, and it matters. E78.9 covers disorders of lipoprotein metabolism generally, which includes deficiency states as well as excess. E78.5 asserts that lipids are high. A record that says only an abnormal lipid panel has not established which of the two applies.

Note also that familial hypercholesterolemia now sits below a subcategory requiring a sixth character, separating homozygous from heterozygous forms with an unspecified option. An encounter form still carrying five characters for familial hypercholesterolemia will be rejected.

3Clinical picture

Clinical findings documented under E78.5

Hyperlipidemia is usually asymptomatic and identified on testing, which shapes what the record contains.

Laboratory

Total cholesterol, LDL, HDL, and triglyceride values from a lipid panel

Risk context

Family history, tobacco use, hypertension, diabetes, obesity

Physical findings

Xanthomas, xanthelasma, or corneal arcus in severe or familial forms

Related conditions

Established atherosclerotic disease, when documented

Secondary causes

Hypothyroidism, kidney disease, liver disease, or medications affecting lipids

The physical findings matter more than their rarity suggests. Documented xanthomas point toward a specific lipid pattern, and tuberous xanthoma is an inclusion term at mixed hyperlipidemia rather than at this code.

4Documentation

What the chart must show

  • A provider-stated diagnosis, since a lipid panel result is a laboratory finding rather than a diagnosis.
  • The lipid panel values, with the elevated fraction identifiable
  • Whether the elevation is cholesterol, triglycerides, or both, stated in the assessment
  • Family history, which distinguishes familial forms carrying their own codes
  • Any secondary cause, including thyroid, renal, hepatic, or medication contributors
  • Current lipid-lowering therapy and the monitoring interval
  • Whether the encounter is screening or management, since that changes how the claim is built

The defect specific to this code is unusual. The specificity is not missing from the char; it is missing from the assessment. A note containing a full lipid panel and an assessment reading only hyperlipidemia has all the information needed for a more precise code and does not use it.

5Decision guide

When to assign E78.5, and when not to

Hyperlipidemia or dyslipidemia, fraction not stated

E78.5

Hypercholesterolemia, triglycerides normal

E78.0-

Familial hypercholesterolemia

E78.01-, with the sixth character for homozygous or heterozygous

Hypertriglyceridemia, cholesterol normal

E78.1

Elevated cholesterol and triglycerides together

E78.2

Combined hyperlipidemia, not stated as familial

E78.2

Familial combined hyperlipidemia

E78.49, which E78.2 excludes

Hyperchylomicronemia

E78.3

Elevated Lipoprotein(a)

E78.41

Lipoprotein disorder with no direction stated

E78.9

Low HDL alone, documented as the only abnormality

Query, since the index routes dyslipidemia to E78.5 but the record describes a deficiency pattern

Screening lipid panel in an asymptomatic patient

The screening encounter code, not E78.5

Abnormal lipid results with no diagnosis stated

Query, since a finding is not a diagnosis

There is no sequencing rule attached to E78.5. Diabetes and hyperlipidemia are reported as separate diagnoses, since the classification provides no combination code pairing them.

Query rather than default when the assessment says only hyperlipidemia while the lipid panel in the same note identifies the elevated fraction, and when a family history suggests a familial form.

6Tabular list

Instructional notes at E78 and above

Inclusion terms at E78.5

None

Excludes1 at E78

Sphingolipidosis (E75.0 to E75.3)

Excludes1 at E78.2

Familial combined hyperlipidemia (E78.49)

Excludes1 at E78.2

Cerebrotendinous cholesterosis (E75.5)

Excludes1 at E70 to E88

Congenital adrenal hyperplasia (E25.0), Marfan syndrome (Q87.4-), androgen insensitivity syndrome (E34.5-), and others

Excludes1 at E00 to E89

Transitory endocrine and metabolic disorders specific to newborn (P70 to P74)

The category is unusually light on instructional notes. E78 carries a single Excludes1, for sphingolipidosis, and E78.5 itself carries none at all, along with no inclusion terms. There is very little in the tabular list constraining this code, which is part of why it gets over-applied.

The Excludes1 that does the most work sits one code away, at mixed hyperlipidemia. Combined hyperlipidemia NOS classifies to E78.2, but familial combined hyperlipidemia is excluded from E78.2 and classifies to E78.49 instead. The word familial moves the code, and the two can never be reported together.

7Comparison

Codes frequently confused with E78.5

E78.00

Descriptor

Pure hypercholesterolemia, unspecified

Use instead when

Cholesterol alone is elevated

E78.01-

Descriptor

Familial hypercholesterolemia, subdivided into homozygous, heterozygous, and unspecified

Use instead when

A familial cholesterol disorder is documented

E78.1

Descriptor

Pure hyperglyceridemia

Use instead when

Triglycerides alone are elevated

E78.2

Descriptor

Mixed hyperlipidemia

Use instead when

Cholesterol and triglycerides are both elevated

E78.3

Descriptor

Hyperchylomicronemia

Use instead when

Chylomicron elevation is documented

E78.41

Descriptor

Elevated Lipoprotein(a)

Use instead when

Lipoprotein(a) is documented as elevated

E78.49

Descriptor

Other hyperlipidemia

Use instead when

Familial combined hyperlipidemia or another named pattern is documented

E78.6

Descriptor

Lipoprotein deficiency

Use instead when

Lipoproteins are deficient rather than elevated

E78.7-

Descriptor

Disorders of bile acid and cholesterol metabolism, including Barth and Smith-Lemli-Opitz syndromes

Use instead when

A named metabolic syndrome is documented

E78.81

Descriptor

Lipoid dermatoarthritis

Use instead when

Lipoid dermatoarthritis is documented

E78.89

Descriptor

Other lipoprotein metabolism disorders

Use instead when

The disorder is named but has no dedicated code

E78.9

Descriptor

Disorder of lipoprotein metabolism, unspecified

Use instead when

A lipid disorder exists without a stated direction

E75.0 to E75.3

Descriptor

Sphingolipidosis

Use instead when

A sphingolipid storage disorder is documented, which the Excludes1 blocks

E75.5

Descriptor

Other lipid storage disorders, including cerebrotendinous cholesterosis

Use instead when

A lipid storage disorder is documented

The E78.9 row is the one worth pausing on. Two unspecified codes in one category are rare, and the difference between them is direction rather than degree. E78.5 says the lipids are high. E78.9 says only that lipoprotein metabolism is disordered.

8Claim context

Services commonly reported with E78.5

E78.5 is one of the highest-volume diagnosis codes in outpatient billing. It supports office evaluation and management, the lipid panels that monitor treatment, and the ongoing management of lipid-lowering therapy.

Screening is where claims most often go wrong. A lipid panel drawn on an asymptomatic patient with no lipid diagnosis is a screening service, and it belongs on the claim with a screening encounter code rather than with E78.5. Attaching a diagnosis code to a screening test misrepresents the encounter and can shift cost to the patient in ways neither the practice nor the patient intended.

Frequency is the second pressure point. Coverage policies for lipid testing set intervals for monitoring a treated patient and separate intervals for screening, and panels drawn more often than the policy allows need a documented reason such as a therapy change or a new symptom. When a patient is on long-term lipid-lowering therapy, report the applicable long-term drug therapy status code. Confirm the applicable local coverage determination before submitting serial testing.

9Denials

Coding errors that cause denials

Coding E78.5 when the lipid panel in the same note identifies the elevated fraction

Assign E78.0-, E78.1, or E78.2 to match the documented pattern

Using E78.5 on a screening lipid panel for an asymptomatic patient

Use the screening encounter code instead

Treating E78.5 and E78.9 as interchangeable

Choose based on whether the record states the lipids are elevated

Reporting E78.2 for familial combined hyperlipidemia

Assign E78.49, since the Excludes1 blocks E78.2

Submitting E78.01 without a sixth character

Add the character for homozygous, heterozygous, or unspecified

Coding E78.5 from a lipid result with no provider diagnosis

Query, since a laboratory finding is not a diagnosis

Billing serial lipid panels with no documented reason

Record the therapy change or clinical question prompting each draw

Missing the long-term drug therapy status code

Add it when the patient is on lipid-lowering therapy

10Sources

Where to verify E78.5

ICD-10-CM Official Guidelines for Coding and Reporting

Conventions on unspecified codes, and the rules separating screening encounters from diagnostic ones

The ICD-10-CM Tabular List at E78

The single category Excludes1, the absence of inclusion terms at E78.5, and the Excludes1 notes at E78.2

The ICD-10-CM Alphabetic Index at Dyslipidemia and Hyperlipidemia

The terms routing to E78.5, including hyperlipoproteinemia and lipoproteinemia

The CMS ICD-10 code page

Current code files and the annual addenda, including the current structure of E78.0-

NCD 190.23, Lipid Testing

Frequency limits for lipid panels, the covered diagnosis list, and the separate cardiovascular screening benefit

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Last reviewed August 2026

This page is a free reference for billing and coding teams and is not coding, legal, or clinical advice. Code selection depends on the documentation in the record and on the policy of the payer being billed. Verify every code, instructional note, and sequencing rule against the current ICD-10-CM files and the Official Guidelines for Coding and Reporting for the applicable date of service. ICD-10-CM is maintained by the CDC's National Center for Health Statistics and published by CMS. CPT is a registered trademark of the American Medical Association. TruCare is not affiliated with CMS, NCHS, the AHA, or the AMA.

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