E78.5

🧬 ICD-10 CM E78.5 — Hyperlipidemia, Unspecified

Billable Code Confirmed

ICD-10 CM E78.5 is a valid, fully billable 5-character ICD-10-CM code for FY2026. It is classified under Chapter 4 (Endocrine, Nutritional and Metabolic Diseases) and falls within the E78 category block covering disorders of lipoprotein metabolism and other lipidemias. The code reaches full specificity at 5 characters and requires no additional characters to be reportable. It is appropriate to use when clinical documentation confirms abnormal lipid levels but does not specify the lipid subtype (e.g., LDL-dominant, triglyceride-dominant, or mixed).¹²

Non-Billable Parent Codes

ICD-10 CM E78 (Disorders of lipoprotein metabolism and other lipidemias) is the 3-character parent category and is not billable — it serves only as a header for the subcategory codes beneath it; additional characters are required to reach a billable level. E78.5 itself is the lowest-level code within its specific subcategory and does not have any further child codes, meaning no additional specificity characters are needed or available.²

Clinical Context

ICD-10 CM E78.5 should be selected only when the provider’s documentation confirms elevated lipid levels but fails to specify whether the elevation is isolated to LDL cholesterol, triglycerides, or a mixed pattern. If lab results clearly show elevated LDL without triglyceride elevation, E78.00 (pure hypercholesterolemia, unspecified) is the more precise choice. When both cholesterol and triglycerides are elevated and documented, E78.2 (mixed hyperlipidemia) is the correct code. CDI professionals and coders should query providers to clarify lipid type before defaulting to E78.5, as specificity improves documentation quality, payer acceptance rates, and clinical data integrity.¹³

Code Classification

ICD-10 CM E78.5 is a diagnosis code (ICD-10-CM), not a procedure code. It represents a clinical finding — abnormally elevated blood lipid levels — classified as a chronic metabolic disorder. This code is used for diagnosis reporting purposes on facility UB-04 claims and professional CMS-1500 claims alike.¹

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🔍 Code Description

ICD-10 CM E78.5 captures the clinical entity of hyperlipidemia in its unspecified form — meaning elevated lipids are confirmed but the precise lipid fraction or disorder subtype is not documented. Lipids circulate in the bloodstream packaged as lipoproteins, including low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL). Elevated LDL and VLDL are associated with atherogenesis and increased cardiovascular risk, while low HDL is an independent risk factor. When a provider notes “hyperlipidemia” or “dyslipidemia” in the record without detailing the specific abnormality, E78.5 is the appropriate catch-all code under the ICD-10-CM conventions for NOS (not otherwise specified) conditions.¹⁴

From an inpatient facility coding perspective, E78.5 most commonly appears as a secondary comorbidity code on an inpatient claim rather than the principal diagnosis. It does not function as a CC (complicating condition) or MCC (major complicating condition) in the MS-DRG system, meaning its presence alone will not shift DRG weight. However, it is clinically relevant for HIM and CDI teams because atherosclerosis and coronary artery disease — which do carry HCC and DRG weight — are frequently driven by or coexist with hyperlipidemia. Documenting and coding E78.5 supports the longitudinal clinical picture even when it does not directly affect reimbursement.⁵

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🌳 Code Tree / Hierarchy

E78 — Disorders of lipoprotein metabolism and other lipidemias ❌ Non-billable
│
├── E78.0 — Pure hypercholesterolemia ❌ Non-billable (parent)
│   │
│   ├── E78.00 — Pure hypercholesterolemia, unspecified ✅ Billable
│   ├── E78.01 — Familial hypercholesterolemia ✅ Billable
│   └── E78.09 — Other pure hypercholesterolemia ✅ Billable
│
├── E78.1 — Pure hypertriglyceridemia ✅ Billable
│
├── E78.2 — Mixed hyperlipidemia ✅ Billable
│
├── E78.3 — Hyperchylomicronemia ✅ Billable
│
├── E78.4 — Other hyperlipidemia ❌ Non-billable (parent)
│   │
│   ├── E78.41 — Elevated lipoprotein(a) ✅ Billable
│   └── E78.49 — Other hyperlipidemia ✅ Billable
│
├── E78.5 — Hyperlipidemia, unspecified ◀ THIS CODE ✅ Billable
│
├── E78.6 — Lipoprotein deficiency ✅ Billable
│
├── E78.7 — Disorders of bile acid and cholesterol metabolism ❌ Non-billable (parent)
│
└── E78.9 — Other and unspecified disorders of lipoprotein metabolism ❌ Non-billable (parent)

Why Not Default to E78.5?

ICD-10 CM E78.5 is the “last resort” in the E78 family — it’s appropriate only when documentation is truly nonspecific. If the provider documents elevated LDL, triglycerides, or a mixed pattern, a more specific sibling code should be assigned. More specific codes reflect better documentation quality and reduce the risk of payer queries or claim rejection.¹³

Familial Hypercholesterolemia Watch

ICD-10 CM E78.01 (Familial hypercholesterolemia) became a valid billable code as of FY2022 and should never be collapsed into E78.5. If the provider documents a genetic or family-pattern LDL elevation, query for familial hypercholesterolemia to support use of E78.01 — this distinction matters for population health reporting and prior authorization for PCSK9 inhibitors.⁷

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✅ Includes

• Hyperlipidemia NOS (not otherwise specified): When provider documentation simply states “hyperlipidemia” without specifying a subtype, E78.5 is the correct default per ICD-10-CM coding conventions for NOS conditions.¹
• Dyslipidemia NOS: The term “dyslipidemia” used generically without specifying the lipid fraction maps to E78.5 as hyperlipidemia unspecified under ICD-10-CM Alphabetic Index guidance.²
• Hyperlipemia NOS: The alternate clinical term “hyperlipemia” without further specification is included under this code per ICD-10-CM tabular includes notes.²
• Elevated lipids, unspecified: When lab values reflect lipid elevation but provider documentation does not clearly link the finding to a specific disorder subtype, this code is appropriate pending further clinical clarification.³
• Combined hyperlipidemia NOS (when not further specified): If a provider writes “combined hyperlipidemia” but does not clearly distinguish a mixed pattern meeting E78.2 criteria, E78.5 may apply unless documentation supports more specificity.⁶

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❌ Excludes

Excludes 1

There are no Excludes 1 notations directly listed under E78.5 in the ICD-10-CM tabular. Excludes 1 at the parent category E78 level relate to codes that represent entirely different conditions that should never be coded simultaneously.²

Common Excludes 1 Error at Category Level

At the E78 category level, coders should not simultaneously assign codes from Chapter 2 (Neoplasms) when a lipid disorder is the direct result of a neoplastic process — the underlying neoplasm coding conventions take precedence. Always review the full tabular Excludes 1 list at both the block and category level, not just at the specific code level, to avoid this error.²

Excludes 2

• E78.6 — Lipoprotein deficiency: This code covers conditions such as hypo-alpha-lipoproteinemia and hypo-beta-lipoproteinemia (low HDL or LDL states). Since E78.6 represents a deficit of lipoproteins rather than excess, it is not mutually exclusive with E78.5 — both conditions can theoretically coexist (e.g., low HDL with elevated LDL/total cholesterol) and may be coded together when individually documented.²⁴

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📋 Clinical Overview

Hyperlipidemia Subtype Specificity: Choosing the Right E78.x Code

The E78 family requires coders to match documentation language precisely to the appropriate code. The most common coding error is defaulting to E78.5 when documentation actually supports a more specific sibling code. Review lab values, provider assessments, and problem list language carefully before code assignment. The table below outlines key differentiators between the most commonly confused E78.x codes.³⁶

Feature	E78.5	E78.00	E78.2
Lipid pattern	Unspecified — no subtype documented	Pure LDL/cholesterol elevation, no triglyceride elevation	Both cholesterol AND triglycerides elevated
Documentation trigger	”Hyperlipidemia” or “dyslipidemia” NOS	”Hypercholesterolemia” or elevated LDL documented	”Mixed hyperlipidemia,” elevated LDL + TG documented
CC/MCC status	Not a CC or MCC	Not a CC or MCC	Not a CC or MCC
HCC mapping (V28)	Not mapped	Not mapped	Not mapped
CDI query value	High — query for specificity	Moderate — confirm absence of TG elevation	Moderate — confirm both fractions are elevated
Payer acceptance	Lower — generic code; may require clarification	Higher — specific lipid fraction documented	Higher — dual elevation confirmed

CDI Trigger: Query for Lipid Specificity

When reviewing H&P or progress notes that list “hyperlipidemia” on the problem list without referencing a lipid panel, CDI professionals should query the provider to specify the elevated fraction. Even a notation of “LDL elevation” or “combined cholesterol and triglyceride elevation” is sufficient to support a more specific code and demonstrates improved clinical documentation quality.³

Manifestations & Symptom Burden

• Atherosclerosis (I70.90): Chronic hyperlipidemia accelerates plaque formation in arterial walls; when documented as a complication or associated condition, atherosclerosis should be coded separately as it carries DRG and HCC implications.⁵
• Xanthomas: Lipid deposits in skin or tendons may be documented in severe or familial cases; when present, evaluate whether E78.01 (familial hypercholesterolemia) is more appropriate.⁷
• Pancreatitis (K85.9): Severe hypertriglyceridemia (not typically E78.5) can trigger acute pancreatitis; if both conditions are documented, code each separately per ICD-10-CM sequencing guidelines.⁴
• Coronary artery disease (I25.10): Hyperlipidemia is a major modifiable risk factor for CAD; when CAD is the reason for admission, I25.10 should be sequenced as principal with E78.5 as a secondary comorbidity.⁵
• Metabolic syndrome: Hyperlipidemia frequently clusters with obesity, hypertension, and insulin resistance; code each documented condition separately — there is no single combination code for metabolic syndrome in **ICD-10-CM.**⁶

Manifestation Coding Note

ICD-10 CM E78.5 is never a manifestation code — it is an etiology/condition code. It does not require a sequencing note such as “code first” or “use additional code” for the condition itself, but coders should apply “use additional code” logic to capture any related manifestations (e.g., xanthelasma, atherosclerosis) that are separately documented and clinically significant.²

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💰 HCC Risk Adjustment

Model	HCC Mapping	HCC Label	RAF Value
CMS-HCC V28 (PY2026)	❌ Not Mapped	N/A	0.000
CMS-HCC V24	❌ Not Mapped	N/A	0.000
RxHCC	❌ Not Mapped	N/A	0.000

ICD-10 CM E78.5 does not map to any HCC category under either the legacy V24 or the current V28 CMS-HCC risk adjustment models, carrying a RAF value of zero.⁸ As of PY2026, CMS Medicare Advantage risk scoring runs exclusively on the V28 model, ending the V24/V28 blended transition period.⁸ The absence of HCC mapping means that E78.5, while clinically important, contributes nothing to a patient’s risk score or premium calculation for Medicare Advantage plans. CDI and coding teams should focus risk adjustment efforts on coexisting conditions — such as ischemic heart disease (HCC 223), diabetes with complications (HCC 35-38), or chronic kidney disease (HCC 329) — that frequently accompany hyperlipidemia and do carry meaningful RAF weight under V28.⁸

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🏥 MS-DRG Assignment

Scenario	MDC	DRG	DRG Title	Relative Weight (approx.)
E78.5 as PDX with MCC	MDC 10	640	Misc. Disorders of Nutrition, Metabolism, Fluids/Electrolytes with MCC	~1.8
E78.5 as PDX with CC	MDC 10	641	Misc. Disorders of Nutrition, Metabolism, Fluids/Electrolytes with CC	~1.1
E78.5 as PDX w/o CC/MCC	MDC 10	642	Misc. Disorders of Nutrition, Metabolism, Fluids/Electrolytes w/o CC/MCC	~0.7
E78.5 as secondary dx	Varies	Determined by PDX	N/A — secondary comorbidity only	N/A

ICD-10 CM E78.5 is almost never the principal diagnosis driving an inpatient admission — it is primarily a chronic comorbidity documented in the medical record and coded as a secondary diagnosis.⁵ When it does appear as principal (rare), it falls under MDC 10 and maps to DRGs 640-642 based on CC/MCC burden from other diagnoses on the claim.⁵ Because E78.5 itself is neither a CC nor an MCC, its presence as a secondary code does not independently improve DRG weight. Coders working inpatient facility claims should focus on accurate CC/MCC capture from other comorbidities (e.g., heart failure, COPD, CKD) that accompany hyperlipidemia and do shift DRG assignment. Always confirm that the principal diagnosis represents the condition chiefly responsible for the admission after study, per UHDDS guidelines, before assigning E78.5 as PDX.⁵

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🔗 Related ICD-10-CM Codes

More Specific Lipid Disorder Codes (Consider Before E78.5)

• E78.00 — Pure hypercholesterolemia, unspecified: Use when documentation confirms elevated LDL/cholesterol without elevated triglycerides.²
• E78.01 — Familial hypercholesterolemia: Use when a genetic or family-pattern hypercholesterolemia is clinically documented.⁷
• E78.1 — Pure hypertriglyceridemia: Use when documentation confirms elevated triglycerides without significant cholesterol elevation.²
• E78.2 — Mixed hyperlipidemia: Use when both cholesterol and triglycerides are elevated and documented.²
• E78.41 — Elevated Lipoprotein(a): Use when Lp(a) elevation is specifically documented; a relatively newer billable code.⁷

Commonly Comorbid Cardiovascular/Metabolic Codes

• I25.10 — Atherosclerotic heart disease of native coronary artery without angina pectoris: Most common cardiovascular complication of chronic hyperlipidemia.⁵
• I10 — Essential (primary) hypertension: Frequently documented alongside hyperlipidemia in metabolic syndrome clusters.⁶
• E11.9 — Type 2 diabetes mellitus without complications: Dyslipidemia is a core component of diabetic metabolic syndrome.⁶
• E66.9 — Obesity, unspecified: Obesity drives secondary hyperlipidemia and commonly co-occurs in inpatient records.⁶
• K85.9 — Acute pancreatitis, unspecified: Severe hypertriglyceridemia (not typically E78.5) can cause pancreatitis; relevant when lipid disorder is causative.⁴

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🛠️ Commonly Associated CPT Codes

• 80061 — Lipid panel (total cholesterol, HDL, triglycerides with calculated LDL): This is the primary diagnostic test prompting an E78.5 code assignment; results of this panel should ideally drive a more specific E78.x code selection if they reflect a clear lipid pattern.³
• 99213/99214 — Office or outpatient E/M, established patient: Hyperlipidemia is among the most frequent chronic conditions managed in outpatient E/M encounters; E78.5 is a common supporting diagnosis on professional claims.¹
• 99232/99233 — Subsequent hospital care E/M: E78.5 appears as secondary diagnosis on inpatient profee E/M claims when hyperlipidemia is among the conditions addressed or managed during the encounter.⁵
• 93000 — Electrocardiogram, routine with interpretation: Often ordered during workup of cardiovascular risk in hyperlipidemic patients; pairs with E78.5 on preventive cardiology encounters.⁵
• 82465 — Cholesterol, serum, total: Standalone cholesterol test (as opposed to full lipid panel) used when only total cholesterol is measured; E78.5 may accompany results pending full panel workup.³
• 96160 — Administration of patient-focused health risk assessment with scoring: Cardiovascular risk screening visits often include lipid disorder documentation; E78.5 may appear alongside preventive medicine codes.¹

NCCI Bundling Considerations

CPT 80061 (lipid panel) bundles the individual component tests (82465, 83718, 84478) under NCCI edits — coders should not bill the panel and its individual components on the same date of service for the same patient.³ E78.5 itself does not drive NCCI bundling decisions, as it is a diagnosis code rather than a procedure code, but it is a required supporting diagnosis to establish medical necessity for lipid panel billing.³ Payers, including Medicare, require documentation of hyperlipidemia or cardiovascular risk factors to support medical necessity for repeat lipid panels; E78.5 satisfies this requirement, though a more specific code is preferred for demonstrating ongoing clinical management.¹

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🔬 ICD-10-PCS Crosswalk

Note: ICD-10-PCS codes apply to inpatient facility procedure reporting only and are not directly “crosswalked” from a diagnosis code. The following PCS codes represent procedures commonly performed in the inpatient setting in patients with E78.5 as a documented comorbidity.

• 5A1221Z — Extracorporeal LDL apheresis: May be performed in severe familial hypercholesterolemia cases resistant to pharmacotherapy; if performed inpatient, this PCS code should accompany the more specific E78.01 rather than E78.5 in most clinical scenarios.²
• 3E033VZ — Introduction of hormone into peripheral vein, percutaneous: Represents parenteral lipid-modifying therapy administration in inpatient settings when oral statins are not feasible; E78.5 would appear as supporting diagnosis.²
• GZJ0ZZZ — Light therapy: Included for completeness; rarely relevant but may appear in complex metabolic inpatient stays where phototherapy is part of a broader treatment protocol.²

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💊 Coding Scenarios and Examples

Scenario 1: Routine Inpatient Admission with Hyperlipidemia as Comorbidity

A 67-year-old male is admitted for exacerbation of chronic systolic heart failure. His problem list includes hypertension, type 2 diabetes without complications, and hyperlipidemia. The provider does not specify the lipid subtype in any of the inpatient notes, and no lipid panel was ordered during this admission. The patient’s medication list includes atorvastatin 40 mg daily, documented as treatment for hyperlipidemia.

Correct Coding:

• I50.22 — Chronic systolic (congestive) heart failure (PDX)
• I10 — Essential hypertension
• E11.9 — Type 2 diabetes mellitus without complications
• E78.5 — Hyperlipidemia, unspecified

Sequencing: I50.22 is correctly sequenced as PDX per UHDDS guidelines (reason for admission after study). E78.5 is appropriate as a secondary comorbidity because the provider documents hyperlipidemia but does not specify a lipid subtype.

CDI Note: CDI should query for lipid specificity to determine if E78.00 or E78.2 is more accurate based on the patient’s ongoing lab history and medication management, even though no lipid panel was drawn this admission.¹⁵

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Scenario 2: Outpatient Visit, Incorrect Default to E78.5

A 54-year-old female presents to her cardiologist for a follow-up after recent coronary artery stenting. Her lipid panel from last week shows total cholesterol 241, LDL 178, HDL 52, triglycerides 132. The physician’s assessment reads: “Hyperlipidemia — continue rosuvastatin.” The coder defaults to E78.5.

Correct Coding (Outpatient/Profee Context):

• I25.10 — Atherosclerotic heart disease of native coronary artery without angina pectoris (or appropriate post-stent code)
• E78.00 — Pure hypercholesterolemia, unspecified (not E78.5 — LDL is the dominant elevation; triglycerides within range)

Sequencing: The cardiovascular condition is the focus of the encounter; E78.00 is secondary. E78.5 would be incorrect here given the available lab data clearly showing isolated LDL elevation.

CDI Note: This scenario illustrates why defaulting to E78.5 when lab data is available and supports more specificity constitutes a coding error. Coders should review available diagnostic data when assigning E78.x codes, even in the outpatient setting.³⁶

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Scenario 3: Inpatient Admission, Hyperlipidemia with Acute Pancreatitis

A 45-year-old male is admitted with acute pancreatitis. The admitting provider notes “hyperlipidemia” on the problem list, and the lipid panel returns with triglycerides of 1,850 mg/dL. The provider documents “hypertriglyceridemia-induced pancreatitis” in the H&P.

Correct Coding:

• K85.9 — Acute pancreatitis, unspecified (PDX — reason for admission)
• E78.1 — Pure hypertriglyceridemia (not E78.5 — triglyceride subtype is now clearly documented)

Sequencing: K85.9 is PDX. E78.1 is secondary, reflecting the documented cause. E78.5 would be incorrect because the provider’s documentation (and lab values) now support E78.1 with specificity.

CDI Note: This scenario is a high-yield CDI opportunity. Initial documentation may have said “hyperlipidemia,” but the subsequent H&P specifying hypertriglyceridemia-induced pancreatitis upgrades the lipid code from E78.5 to E78.1. CDI teams should monitor admission diagnoses for this pattern.⁴⁶

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⚠️ Coding Pitfalls and Tips

1. Don’t Default to E78.5 When Lab Data Supports Specificity. The most common coding error with this code is assigning E78.5 when a lipid panel is available in the record that clearly supports a more specific code. Per ICD-10-CM coding conventions, when documentation (including diagnostic results available to the provider) supports a more specific code, the coder should use the more specific option or query the provider. Defaulting to the unspecified code when specificity is achievable is a documentation integrity issue that auditors frequently flag.³⁶

2. E78.5 is Not a CC or MCC — Do Not Over-Rely on It for DRG Impact. Some newer coders mistakenly believe that adding more secondary diagnosis codes always improves DRG reimbursement. E78.5 is neither a CC nor an MCC under the MS-DRG system, so its presence as a secondary code does not change the DRG assignment or relative weight. Focus your secondary diagnosis capture efforts on conditions that do qualify as CC or MCC to maximize appropriate DRG optimization.⁵

3. Medication Lists Are Not Sufficient Alone for Code Reporting. A statin on the medication list (e.g., atorvastatin, rosuvastatin) is a strong indicator that hyperlipidemia exists, but the condition must still be documented by the provider as a current, active diagnosis to be reported per ICD-10-CM Official Guidelines Section III (Reporting Additional Diagnoses). If the provider does not list hyperlipidemia in the assessment, CDI should query — coders cannot infer a diagnosis solely from a medication list for inpatient reporting.⁵

4. History of Hyperlipidemia Codes Differently. When a provider documents “history of hyperlipidemia” and the patient is no longer on treatment and lipids are controlled, the appropriate code is Z87.39 (personal history of other endocrine, nutritional and metabolic diseases), NOT E78.5. However, if the condition is chronic and actively managed with medication, it is still reportable as E78.5 per UHDDS guidelines regardless of whether it is addressed at every encounter.²⁵

5. Don’t Confuse E78.5 With E78.4x or E78.49. E78.4- (Other hyperlipidemias) and its child codes (E78.41 — Elevated Lp(a), E78.49 — Other hyperlipidemia) are sometimes used interchangeably with E78.5 by less experienced coders. E78.5 is specifically for unspecified hyperlipidemia, while E78.49 captures other specified forms that don’t fit the primary subtypes. Ensure you’re not collapsing a documented, specified condition into the unspecified category.²⁷

6. Query Opportunity: “Metabolic Syndrome” Documentation. Providers frequently document “metabolic syndrome” as a diagnosis, but ICD-10-CM has no single combination code for this entity — each component (hypertension, obesity, diabetes, dyslipidemia) must be coded separately. When “metabolic syndrome” is documented, query the provider for the individual components, and assign E78.5 (or a more specific lipid code) alongside the other confirmed diagnoses. This is a high-yield CDI touchpoint for inpatient coders.⁶

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📚 Sources

1. American Academy of Professional Coders (AAPC). *ICD-10-CM Code E78.5 — Hyperlipidemia, Unspecified.* AAPC Code Reference. https://www.aapc.com/codes/icd-10-codes/E78.5 (2026). 2. National Center for Health Statistics (NCHS) / Centers for Medicare & Medicaid Services (CMS). *ICD-10-CM Official Guidelines for Coding and Reporting, FY2026.* U.S. Department of Health & Human Services (2026). 3. CareCloud. *ICD-10 Code E78.5 — Hyperlipidemia, Unspecified.* https://carecloud.com/icd-10-codes/e78-5/ (2025). 4. RCM Matter. *Hyperlipidemia ICD-10: E78.5 and Related Conditions.* https://rcmmatter.com/blogs/articles/hyperlipidemia-icd-10-e78-5 (2025). 5. CMS. *MS-DRG Definitions Manual, Version 41, FY2024-FY2026.* Centers for Medicare & Medicaid Services. 6. MedStates. *ICD-10 Code for Hyperlipidemia: E78 Coding and Billing.* https://www.medstates.com/understanding-icd-10-code-hyperlipidemia-and-its-importance/ (2025). 7. HIA Code. *FY2026 ICD-10-CM Code Updates.* https://hiacode.com/blog/new-icd-10-cm-codes (2025). 8. Rebellis Group. *Medicare Advantage Risk Adjustment: Transition from V24 to V28.* https://www.rebellisgroup.com/post/risk-adjustment-is-your-organization-ready-for-the-transition-from-v24-to-v28 (2023).