Primary Care Coding Alert

Time to get hip to the ‘hypers.’

You know from your introductory coding classes that the Greek prefix “hyper” means “excessive.” In medical terms, the prefix is used when normal levels of a certain substance or chemical in the body are elevated.

Unfortunately, when it comes to cholesterol coding, the prefix is used in conjunction with a number of conditions, which creates some similar-sounding disorders and the potential for lots of confusion from a coding perspective. But if you know your “hypers,” you can code any cholesterol-related diagnosis with confidence and accuracy.

Know That Hyperlipidemia and Hyperlipemia Are the Same Thing

Confusingly, when you look up hyperlipidemia in the ICD-10 index, the first term you encounter is hyperlipemia, though you will find hyperlipidemia right next to it on the same line. But don’t worry. “The terms refer to the same condition, but currently hyperlipidemia is the most current clinical term for a condition that denotes a high concentration of lipids, or fat, in the blood,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

How is it coded? “You’ll use E78.5 [Hyperlipidemia, unspecified] if the type of hyperlipidemia isn’t specified by the physician rather than E78.49 [Other hyperlipidemia], which is for specific hyperlipidemias that don’t have their own code elsewhere in the code family,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

One of those specified hyperlipidemias, listed as a synonym for E78.49, is familial combined hyperlipidemia, which you would use when the condition is genetic in nature rather than the result of diet and lifestyle choices.

Know Which Lipids and Lipoproteins Are Elevated

The key to more specific hyperlipidemia coding lies in understanding that the term hyperlipidemia is actually an umbrella term for all conditions where elevated lipids exist in the blood, which is why ICD-10 uses the unspecified code for the more general condition. Additionally, the term lipid itself is a general term for several substances, including cholesterol and triglycerides. To complicate matters further, those substances are transported through the body in blood plasma by four different lipoproteins: chylomicrons, very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL).

So, “when a specific lipoprotein, lipoprotein(a), is elevated, you’ll use E78.41 [Elevated Lipoprotein(a)],” Witt advises.

Know the Other “Hypers” for Specificity

Hypercholesterolemia: This term is used for patients with elevated low-density lipoprotein (LDL) cholesterol in the blood. Over time, these patients run the risk of such conditions as hypertension, stroke and heart disease, as elevated LDL produces plaque in the blood vessels, blocking the flow of blood.

How is it coded? You would code this with E78.00 (Pure hypercholesterolemia, unspecified) if not otherwise specified. If the hypercholesterolemia happens to be genetic in nature rather than the result of diet and lifestyle choices, like E78.49, you’ll use E78.01 (Familial hypercholesterolemia).

Hyperglyceridemia: In this condition, patients are experiencing high levels of triglycerides, which can lead to atherosclerosis, cardiovascular disease, and acute pancreatitis.

How is it coded? This is a straightforward code choice of E78.1 (Pure hyperglyceridemia), which you can also use for a patient with high levels of very-low-density lipoproteins (VLDL), or hyperlipoproteinemia.

Coding alert: To code a patient with both elevated cholesterol and triglycerides (mixed hypercholesterolemia and hyperglyceridemia), you’ll use E78.2 (Mixed hyperlipidemia). And if the patient has combined elevated cholesterol and triglycerides due to genetics, you’ll use E78.4 (Other hyperlipidemia), since an Excludes1 note under E78.2 directs you to E78.49 for familial combined hyperlipidemia.

Hyperchylomicronemia: In this condition, levels of the lipoprotein chylomicron are elevated.

How is it coded? Again, this is a straightforward code — E78.3 (Hyperchylomicronemia) — though as this is a very rare condition, as a primary care coder, it’s a choice you’ll rarely, if ever, have to make.

And Don’t Forget This Encounter Code …

As most of these specified conditions will be diagnosed using definitive lab results, you’ll also need to have Z13.220 (Encounter for screening for lipoid disorders) at your fingertips. As the code’s synonyms tell you, you will use this when your provider uses a test to screen the patient’s cholesterol level for hypercholesterolemia or hyperlipidemia.

… and These Last Two Pieces of Advice

First, “it is important that coders should not confuse hyperlipidemia, or elevated lipid levels, with lipoprotein deficiency, or depressed lipoprotein levels, which is coded to E78.6 [Lipoprotein deficiency],” says Moore.

Additionally, “it is important that the provider, not the coder, determine the type of problem the patient has. In the majority of cases, lazy coding by the provider who selects the default code in the electronic health record [EHR] will lead to an unspecified code being reported. But if the patient has definitive lab results and is being treated, it behooves the provider to report the most specific code. In this case, provider education may be in order, especially if the patient is being prescribed drugs or treatments that require a specific cause,” Witt concludes.