Pre-Op Clearance Coding Practice Questions

These questions practice preoperative examination coding: choosing the Z01.81- code, placing the reason for the surgery, and handling findings from the evaluation. Each answer cites the FY 2027 ICD-10-CM Official Guidelines or Tabular List. The scenarios are short and synthetic; they are written for this page and do not repeat any Etio case.

1. Question 1

   A surgeon requests a cardiac risk evaluation before a planned laparoscopic cholecystectomy for gallstones without cholecystitis or obstruction. The cardiologist documents a preoperative cardiovascular examination, and no treatment is given. Which code is listed first?

   • A. K80.20
   • B. Z01.818
   • C. Z01.810
   • D. Z01.812
   Show answer and explanation

   Answer: C. Z01.810

   For a preoperative evaluation only, a code from Z01.81- is sequenced first. The documentation describes a cardiovascular examination, so Z01.810 is more specific than the catch-all Z01.818. Z01.812 describes a preprocedural laboratory examination.

   Sources: ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.F.3, Highest level of specificity

   Practice this rule: Preoperative Medical Evaluation

2. Question 2

   For the same encounter, where is K80.20, Calculus of gallbladder without cholecystitis without obstruction, reported?

   • A. First, because it is the reason for the surgery
   • B. As an additional diagnosis after Z01.810
   • C. It is not reported for a clearance encounter
   • D. Only on the claim for the surgery itself
   Show answer and explanation

   Answer: B. As an additional diagnosis after Z01.810

   The guidelines assign the condition that is the reason for the surgery as an additional diagnosis on a preoperative evaluation. It explains why the clearance was needed, but the Z01.81- code describes what the encounter was for.

   Sources: ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only

   Practice this rule: Preoperative Medical Evaluation

3. Question 3

   A primary care provider performs a preoperative history and physical before surgery for an age-related nuclear cataract of the left eye. The note documents a preoperative examination without describing it as cardiovascular, respiratory, or laboratory. No problems are found. Which code set is correct?

   • A. Z01.818, H25.12
   • B. H25.12, Z01.818
   • C. Z01.810, H25.12
   • D. Z01.818, H25.10
   Show answer and explanation

   Answer: A. Z01.818, H25.12

   Z01.818 includes preprocedural examination NOS, which fits an exam documented without a named system. The reason for surgery follows as an additional diagnosis. The record states the left eye, so H25.12 is correct and the unspecified eye code H25.10 is not.

   Sources: FY 2027 ICD-10-CM Tabular List and Alphabetic Index, Tabular List, code Z01.818; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section I.B.13, Laterality

   Practice this rule: Mobility Concern and Prior Procedure Review, Activity-Related Joint Concern

4. Question 4

   A patient comes in only to have blood and urine tests drawn that the surgeon ordered before a scheduled procedure. Which code is listed first?

   • A. Z01.812
   • B. Z01.89
   • C. Z00.00
   • D. Z01.818
   Show answer and explanation

   Answer: A. Z01.812

   The Tabular List includes blood and urine tests prior to treatment or procedure at Z01.812, Encounter for preprocedural laboratory examination, and a Z01.81- code is sequenced first for a preoperative encounter. Z01.89 is assigned for routine laboratory or radiology testing in the absence of signs, symptoms, or an associated diagnosis; these tests are preprocedural, which Z01.812 describes.

   Sources: FY 2027 ICD-10-CM Tabular List and Alphabetic Index, Tabular List, code Z01.812; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.K, Patients receiving diagnostic services only

   Practice this rule: Preoperative Medical Evaluation

5. Question 5

   Before an elective left hip replacement for unilateral primary osteoarthritis of the left hip, a pulmonologist performs a preoperative respiratory examination. The patient's chronic obstructive pulmonary disease is evaluated to judge surgical risk and is documented as stable. Which code set is correct?

   • A. J44.9, Z01.811, M16.12
   • B. Z01.811, M16.12, J44.9
   • C. Z01.811, J44.9
   • D. M16.12, Z01.811, J44.9
   Show answer and explanation

   Answer: B. Z01.811, M16.12, J44.9

   Z01.811 describes the preprocedural respiratory examination and is listed first. The reason for the surgery, M16.12, is an additional diagnosis. The COPD was part of the risk evaluation, so it is coded as a finding related to the pre-op evaluation. Option C leaves out the reason for surgery.

   Sources: ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only; FY 2027 ICD-10-CM Code Descriptions in Tabular Order, Codes Z01.811, M16.12, J44.9

   Practice this rule: Breathing Follow-Up and History Review, Preoperative Medical Evaluation

6. Question 6

   Which encounter does the FY 2027 Tabular List include at Z01.818, Encounter for other preprocedural examination?

   • A. An examination before antineoplastic chemotherapy
   • B. A pre-employment physical
   • C. A screening test for diabetes in a well adult
   • D. A general adult exam with abnormal findings
   Show answer and explanation

   Answer: A. An examination before antineoplastic chemotherapy

   Encounter for examinations prior to antineoplastic chemotherapy is an inclusion term at Z01.818. A pre-employment physical is an administrative examination in category Z02, screening is excluded from category Z01 and coded from Z11 to Z13, and a general adult exam with abnormal findings is Z00.01.

   Sources: FY 2027 ICD-10-CM Tabular List and Alphabetic Index, Tabular List, category Z01 and code Z01.818; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section I.C.21.c.12, Routine and Administrative Examinations

   Practice this rule: Routine Adult Health Examination, Preoperative Medical Evaluation

7. Question 7

   A patient arrives for scheduled outpatient same-day laparoscopic cholecystectomy for gallstones without cholecystitis or obstruction. The surgery is cancelled because of a contraindication identified on arrival. What is the first-listed diagnosis?

   • A. Z01.818
   • B. K80.20
   • C. Z01.810
   • D. A code for the contraindication only
   Show answer and explanation

   Answer: B. K80.20

   For outpatient same-day surgery, the reason for the surgery is the first-listed diagnosis, even if the surgery is not performed because of a contraindication. Z01.81- codes describe encounters for preoperative evaluations only, not the surgical encounter itself.

   Sources: ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.A.1, Outpatient Surgery; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only

   Practice this rule: Preoperative Medical Evaluation

8. Question 8

   During a preoperative cardiovascular examination, the electrocardiogram shows an irregular rhythm and the cardiologist documents a new diagnosis of paroxysmal atrial fibrillation. The cardiologist recommends postponing the procedure for further evaluation, and no treatment is started at this visit. How is the atrial fibrillation reported?

   • A. As the first-listed diagnosis in place of Z01.810
   • B. As an additional diagnosis, with Z01.810 still listed first
   • C. It is not coded on a clearance encounter
   • D. By replacing Z01.810 with Z01.818
   Show answer and explanation

   Answer: B. As an additional diagnosis, with Z01.810 still listed first

   The guidelines say to code also any findings related to the pre-op evaluation, so I48.0, Paroxysmal atrial fibrillation, is an additional diagnosis. The encounter remained a clearance evaluation with no treatment given, so the Z01.810 code still describes it and stays first.

   Sources: ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section IV.M, Patients receiving preoperative evaluations only; ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section I.C.21.c.12, Routine and Administrative Examinations

   Practice this rule: Preoperative Medical Evaluation, Exertional Chest Discomfort Review