Billing codes · ICD-10-CM code
E78 hyperlipidemia codes on nutrition claims
By Javier Alvarez · Updated · 4 min read
| Category | E78, Disorders of lipoprotein metabolism and other lipidemias |
|---|---|
| Common on MNT claims | E78.5, E78.00, E78.2, E78.1, E78.49, E78.41 |
| Not billable (headers) | E78, E78.0, E78.01, E78.4 |
| FY2026 change (Oct 1, 2025) | E78.01 split into E78.010 (HoFH), E78.011 (HeFH), E78.019 (unspecified) |
| Preventive hook | USPSTF B: behavioral counseling for adults with CVD risk factors (2020) |
| Medicare MNT | Not a qualifying diagnosis alone |
| FY2027 change | None to E78 (Oct 1, 2026) |
Cardiology and primary care referrals for "high cholesterol" are common in outpatient nutrition, and the claims usually aren't hard. What decides whether they pay is the benefit route. The lipid code is one of the diagnoses payers use to decide between preventive counseling and medical nutrition therapy.
E78 codes with plain-English descriptors
| Code | Descriptor | In plain terms |
|---|---|---|
| E78.00 | Pure hypercholesterolemia, unspecified | High cholesterol/LDL, triglycerides not the issue |
| E78.010 | Homozygous familial hypercholesterolemia [HoFH] | Inherited, two copies (FY2026) |
| E78.011 | Heterozygous familial hypercholesterolemia [HeFH] | Inherited, one copy (FY2026) |
| E78.019 | Familial hypercholesterolemia, unspecified | Familial, type not stated (FY2026) |
| E78.1 | Pure hyperglyceridemia | High triglycerides only |
| E78.2 | Mixed hyperlipidemia | High cholesterol and high triglycerides |
| E78.3 | Hyperchylomicronemia | Very high triglycerides from chylomicrons |
| E78.41 | Elevated Lipoprotein(a) | High Lp(a) |
| E78.49 | Other hyperlipidemia | A specified type with no better code |
| E78.5 | Hyperlipidemia, unspecified | "Hyperlipidemia" or "dyslipidemia" with no type |
Headers you can't bill: E78, E78.0, E78.01 (since October 1, 2025) and E78.4.
What changed recently
- FY2026 (October 1, 2025): familial hypercholesterolemia went from one code (E78.01) to three (E78.010, E78.011, E78.019). If a claim template still uses E78.01, visits from October 1, 2025 will reject as invalid.
- FY2027 (October 1, 2026): no changes to E78.
Choosing the most specific code
Use the provider's words:
- "Hypercholesterolemia" or "high LDL" → E78.00
- "Hypertriglyceridemia" → E78.1
- "Mixed hyperlipidemia" or "combined hyperlipidemia" → E78.2 (familial combined hyperlipidemia indexes to E78.49)
- "Familial hypercholesterolemia" → E78.010/E78.011/E78.019, depending on what's documented
- "Hyperlipidemia" or "dyslipidemia," unspecified → E78.5
As with every medical diagnosis on a nutrition claim, you code from the referral or chart. A lipid panel in your note is supporting evidence. It doesn't let you change the diagnosis yourself.
Coverage: preventive CVD counseling vs. medical MNT
Preventive. The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioral counseling for a healthy diet and physical activity (grade B, November 2020). Payers turn that into code lists:
- UnitedHealthcare (MP.016.59, eff. 7/1/2026) lists MNT codes 97802-97804 and G0270/G0271 in its Healthy Diet and Physical Activity for CVD Prevention row. One of the row's diagnoses is required. The list includes E78.00, E78.010, E78.011, E78.019, E78.1, E78.2, E78.3, E78.41, E78.49 and E78.5, along with hypertension, overweight with BMI codes, obesity, impaired fasting glucose and metabolic syndrome.
- Aetna (CPB 0049) covers counseling as preventive for adults who are overweight and have cardiovascular risk factors, dyslipidemia among them.
- Cigna (A004) uses its designated wellness code list in the primary position for preventive nutrition counseling. Z71.3 is on that list.
Medical. When lipid counseling is part of treating a disease the plan covers under the medical benefit, it's billed as MNT with deductible and copay. Many plans cover it that way. Some don't cover nutrition therapy for hyperlipidemia at all outside the preventive benefit. Check the member's benefit.
Medicare. Part B MNT covers diabetes and renal disease only (NCD 180.1). A patient with hyperlipidemia and type 2 diabetes can be seen under MNT on the diabetes diagnosis, with E78 as a secondary code. Medicare's cardiovascular behavioral therapy benefit (G0446) is a primary-care service.
Pairing with CPT codes and other diagnoses
| Scenario | Diagnosis order (example) |
|---|---|
| UHC commercial, lipid counseling | A: E78.2 |
| Plan whose preventive benefit needs a wellness code first | A: Z71.3, B: E78.00 |
| Overweight with dyslipidemia | A: E78.5, B: E66.3, C: Z68.28 |
| Lipids with prediabetes | A: E78.5, B: R73.03 |
| Medicare, diabetes with hyperlipidemia | A: E11.9, B: E78.5 |
Use 97802 for the initial assessment and 97803 for follow-ups, with units from time face to face. Point the service line at the diagnosis the payer's policy keys on. Z71.3 and E66 obesity codes cover the partner codes.
What the note must show
- The provider's lipid diagnosis, from the referral or chart.
- Other cardiovascular risk factors that support preventive routing (blood pressure, weight/BMI, glucose status), when they're documented.
- Your assessment of intake, the intervention (e.g., saturated fat, fiber, pattern changes) and measurable goals.
- Time face to face for units.
Denials and fixes
| What you'll see | Likely cause | Fix |
|---|---|---|
| Rejected: invalid diagnosis | E78.01 on a date of service from Oct 1, 2025, or a header | E78.010/E78.011/E78.019 or another billable E78 code |
| CO-167 from Medicare | Hyperlipidemia only | Not an MNT diagnosis; bill diabetes/renal if documented |
| Paid to deductible | Plan's preventive row wanted a different first code | Check the policy; corrected claim if documentation supports it |
| PR-204 | No nutrition benefit on the plan | Patient discussion; verify before the next visit |
The routing logic is laid out in preventive vs. medical benefits, and denial codes in why nutrition claims get denied. For the rest of the codes, see the MNT billing codes reference.
For the other diagnosis codes on nutrition claims, see the ICD-10 codes for dietitians reference.