ICD-10 Codes for Pre Operative Clearance

Do you know which ICD 10 codes are assigned with preoperational clearances? Z01.8 is the primary ICD 10 code for preoperational clearances. Since it is non-billable, you cannot convert it to an ICD 9 code.

You can also find the secondary codes associated with preoperational clearances from our blog. We will explain payment considerations, billing guidelines, and documenting evaluations as well. 

Further, drive better outcomes with our efficient coding service. Our team ensures ICD-10 accuracy, improving your claims and reimbursements. Find out more about our services today.

List of ICD-10 Codes for Pre Operative Clearance

The preoperative clearance codes come under Z01.8 which is associated with “other specified special examinations”. There are specific codes for the examinations of some defined health departments. Such departments include eyes, ears, dental, blood pressure, and gynecology. The Z01.8 code covers examinations of all the medical fields other than these departments.

There are five types of codes associated with Z01.8. One of those types has four subtypes that comprise the codes for preprocedural examinations. Here is the hierarchy of the codes for “other specified special examinations” explained:

ICD 10 Code Z01.81

The Z01.81 code is associated with encounters for preprocedural examinations. It is non-billable and thus cannot be converted to the ICD 9 code version. It has four subtypes for specific preprocedural examinations.

• ICD 10 Code Z01.810: This code is linked with encounters for preprocedural cardiovascular examinations. It is billable and can be directly converted to the ICD 9 code V72.81.
• ICD 10 Code Z01.811: You can use Z01.811 for preprocedural respiratory examinations. It is also billable and can be directly converted to V72.82 in the ICD 9 code version.
• ICD 10 Code Z01.812: Z01.812 is a billable code associated with preprocedural laboratory examinations. You can directly convert it to the ICD 9 code V72.63.
• ICD 10 Code Z01.818: You can use this code for other preprocedural examinations other than the specified ones above. It is also billable and can be directly converted to the ICD 9 V72.83 code.

ICD 10 Code Z01.82

This code covers the encounters for allergy testing. It is a billable code and can be directly converted to the ICD 9 code V72.7.

ICD 10 Code Z01.83

You can use the Z01.83 code for blood typing encounters. It is another billable code that can be converted to the ICD 9 code V72.86.

ICD 10 Code Z01.84

The Z01.84 code can be used in encounters for antibody response examinations. Since it is billable, you can convert it to V72.61 in the ICD 9 code version.

ICD 10 Code Z01.89

There are some specified special examinations other than the ones discussed above. You can use the Z01.84 code for those examinations since it is billable. It can be directly converted to the ICD 9 code V72.85.

You must carefully apply these codes to ensure accurate documentation of your preoperative clearance examinations. This way, their documentation is based on the set procedural framework. It also aligns with the relevant coding conventions.

What is Preoperative Clearance?

Sometimes, physicians decide that preoperative assessments have to be conducted on their patients. This assessment involves taking the history and a physical examination of those patients. You also have to review their available medical records and laboratory tests. 

There are some pre-operative checkups conducted as well. They depend on the condition of patients at that time. Those checkups usually include imaging studies like X-rays, ultrasounds, and CT scans.

However, insurance companies do not deem all preoperative clearances as medically necessary. Their decisions are made based on CMS policies. It is also possible for Medicare to decline coverage for some pre-operative clearances.

How Are Payment Considerations Determined?

There are three ways in which you can determine certain payment considerations. Let’s take a look at them:

• Coverage under the Social Security Act (SSA)

Medicare provides certain benefits to patients who undergo medical procedures. All those benefits fall under the regulations of the SSA. This means that it is important for Medicare to ensure that their coverage decisions match the regulations and guidelines set by the SSA.

• Medically Necessary Diagnosis and Treatments

Insurance companies can only consider the coverage of patients if they deem the relevant diagnosis and subsequent treatments as medically necessary. The objective of insurers is to increase the well-being and overall functioning of patients. And they carry out their objectives through these interventions.

• Potential for Insurance Coverage

Insurance companies can also cover specific preventive medical services. These services contain certain aspects of pre-operative clearances. For this to happen, the patients must understand the limits of their insurance coverage.

Who Can Perform Preoperative Clearances?

Preoperative clearances are mostly performed by specialists and internal medicine physicians. These healthcare providers are the ones who manage specific conditions that affect surgeries. This is why they are highly important for preoperative CPT codes. Many surgeons often bill the visits for preoperative clearances without realizing something.

They do not realize that these evaluations come under the global surgical package once they decide to perform surgery. You must also understand that the package also has another type of patient visit. These visits involve surgeons who perform a preoperative history and physical (H&P) of their patients.

The set CPT guidelines state that they cannot bill the H&P separately with the usage of the modifier -24. The global package also comprises the subsequent visits made before surgeries but after the decision. Consider an example of a patient who has to undergo surgery but delays it.

She delays it for a few months due to her scheduling conflicts. Her surgeon brings her to his office for an evaluation. It is important to note here that this is done the day before surgery. Now this additional visit is not separately billable. The insurance company pays them for the entire package.

They do not have to unbundle the services that the insurer is already paying them for. Medical services are separately reportable if they are unrelated to a surgery. But you will have to use a diagnosis that is unrelated to that surgery as well.

What Are the Billing Guidelines for Preoperative Clearance?

You should precisely follow the set guidelines while billing preoperative exams. There are some scenarios in which the preoperative evaluation lacks medical necessity. In such scenarios, you should always ensure that the Modifier GY is present with the E/M procedural codes.

This modifier indicates that the relevant services are not to be considered as covered Medicare benefits. This way, you can ensure transparency while processing your medical bills. Healthcare providers should carefully implement the relevant procedures for preoperative clearance exams.

In this case, Section 4, Part M of the ICD-10 official coding guidelines comes in handy. You must always select the most fitting Evaluation and Management code. This way, you can ensure that you have accurately processed your claims.

Consider those patients who exclusively undergo preoperative evaluations. For such cases, you are specifically mandated to use codes from the Z01.81 subcategory. It is an effective coding approach that follows all the set industry standards. It also ensures a seamless reimbursement process for healthcare providers.

How to Document Preoperative Medical Evaluation?

The Georgia Academy of Family Physicians set certain guidelines in 2016. Those guidelines state that you must maintain comprehensive documents. This should be ensured whenever you are submitting the bills for preoperative evaluations. You should also have detailed notes composed of three crucial elements:

• Referral Source Confirmation

You should clearly reference the requests initiated for your preoperative medical evaluations. These requests are always initiated by the Primary Care Physician (PCP). It is a verification process that underlines the necessity and origin of your evaluations.

• Specific Medical Focus

You must also document the exact medical conditions as well. These conditions are always identified as focal points. This is because they are used during the assessment phase of a medical evaluation.

Therefore, you always have to record these details. This way, you can create an important correlation. This correlation maintains a direct relationship between the evaluation’s purpose and the patient’s medical context.

• Physician Opinion Acknowledgment

The notes of healthcare providers must include a certain aspect of evidence as well. It should be confirmed that the assessments and opinions of healthcare providers are forwarded to the relevant insurance companies.

These assessments and opinions have to be made based on surgical clearance examinations. This way, you can ensure a seamless feedback loop. This loop can be significantly beneficial for the medical evaluation and the provider’s requisition.

The Bottom Line

The Z01.810, Z01.811, Z01.812, and Z01.818 codes are used for preoperative clearances. Physicians decide that preoperative assessments have to be conducted on their patients.

Payment considerations are determined based on SSA coverage, medically necessary diagnosis, and coverage potentials. Contact Health Quest Billing to ensure that your ICD 10 codes are accurately assigned.