Pre-Procedural Examinations – Z01.818

In the past, we typically thought of pre-operative examinations prior to surgery, not diagnostic tests or other procedures. However, the ICD-10-CM code Z01.818 today reads, other pre-procedural, not pre-operative. That’s because special exams are needed for more than just pre-surgery clearance. This opens the door for other types of procedures, including diagnostic tests, for medically necessary clearance exams.

Z01.818 – Encounter for other preprocedural examination | ICD-10-CM

Let’s take a look at a few ways this ICD-10-CM code set may be used.

Scenario 1:

An elementary aged child with Autism needs an MRI. The physician ordering the MRI requests their pediatrician to evaluate whether or not they would benefit from moderate conscious sedation during the MRI. The child had an abnormal EEG.

CPT Code:  Depending on the criteria and the payer, either an outpatient office or consultation code can be used here

ICD-10-CM Codes: (According to the guidelines, Z01.818 is the primary diagnosis, as it is the sole reason for the encounter)

  1. Z01.818 – Encounter for OTHER pre-procedural exam (PRIMARY DIAGNOSIS)
  2. Abnormal EEG – Reason for MRI
  3. Autism – Reason for the pre-procedural examination

ICD-10-CM guidelines specify that these diagnosis, in this order, is how you are to report a pre-procedural examination. When you perform this service without the Z-code, the codes sent to the payer appear like a regular E/M service for conditions you are treating, not a pre-procedural clearance exam.

Pre-procedural examinations are not limited to the outpatient office. They may be performed in any setting where they are needed. Pre-procedural exams may not be used just to satisfy the hospital’s criteria to have an H&P on file within the last 30 days. The documentation for the pre-procedural exam should support the medical necessity of the service, and all diagnosis needed to report the service.

Scenario 2:

If you have a very specific reason for the pre-procedural procedure, such as a pulmonary or cardiovascular issue, there are more specific ICD-10-CM pre-procedural codes for those.

Z01.810– Encounter for pre-procedural cardiovascular examination | ICD-10-CM

Z01.811 – Encounter for pre-procedural respiratory examination | ICD-10-CM

Z01.812 – Encounter for pre-procedural laboratory examination | ICD-10-CM

Again, these ICD-10-CM codes would fall in the primary code spot, with the reason for the procedure in second, and the reason that prompted the clearance or any other condition to be considered is third, and so on.

If you are performing pre-procedural examinations, and would like to have someone talk with your group, please reach out to Jay.McVean@uth.tmc.edu or Caroline.Wolbrecht@uth.tmc.edu.

Resources:

MSHBC:  Pre-procedural Tip Sheet

2024 ICD-10-CM Guidelines :

Page G33 – Category of Z-Codes, 16) Z-Codes That May Only be Principal/First Listed Diagnosis, Left Lower Column, Z01-

Page G36 – Patients receiving pre-op evaluation only