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2025 ICD-10-CM code Z01.812

Encounter for preprocedural laboratory examination; blood and urine tests before a treatment or procedure.

Always ensure the primary diagnosis reflects the reason for the encounter.Z01.812 should only be used when preprocedural laboratory exams are the primary reason for the visit; if other issues are addressed during this visit, appropriate codes for these conditions must also be included.

Modifiers are not applicable to ICD-10 codes.Modifiers are used with CPT and HCPCS codes to provide additional information about the services provided.

Medical necessity is established by the physician's determination that preprocedural laboratory tests are required to evaluate the patient's health status and suitability for the planned procedure, thereby potentially preventing complications or altering the plan of care.

The clinical responsibility lies with the physician ordering and interpreting the preprocedural laboratory tests. This may involve a primary care physician, specialist, or the anesthesiologist depending on the context. The lab performing the tests has the responsibility of accurate performance and reporting.

IMPORTANT:Consider Z00.00 (Encounter for general adult medical examination without abnormal findings), Z01.84 (Encounter for antibody response examination), or Z01.89 (Encounter for other specified special examinations) depending on the specifics of the encounter and the reason for the examinations.If the tests are related to a specific condition, that condition's ICD-10 code should be the primary diagnosis.

In simple words: This code means the patient went to the doctor or lab for blood and urine tests before a planned medical procedure or treatment. These tests help doctors decide if the patient is healthy enough for the procedure and to plan the best treatment.

This ICD-10-CM code signifies an encounter with healthcare services specifically for preprocedural laboratory examinations.These examinations involve tests conducted on blood and/or urine samples to assess a patient's health status before a planned medical procedure or treatment. The purpose is to evaluate suitability for the procedure and inform treatment decisions, potentially revealing contraindications or requiring adjustments to the planned intervention.It is crucial that the code is used only when the laboratory examinations are specifically undertaken for a pre-existing scheduled procedure.It should not be used as the principal diagnosis.

Example 1: A patient is scheduled for a cardiac catheterization.Prior to the procedure, blood tests (including a complete blood count and coagulation studies) and a urinalysis are performed.Z01.812 is used to code the encounter for these preprocedural laboratory tests. The primary diagnosis would be the reason for the catheterization (e.g., suspected coronary artery disease)., A patient is scheduled for elective surgery. Preoperative blood work (including a complete metabolic panel and liver function tests) and a urine sample for drug screening are ordered to assess the patient's overall health and risk factors before surgery. Z01.812 would code the encounter for these tests, along with the appropriate ICD-10 code for the reason for the surgery., A patient is undergoing a series of pre-transplant evaluations before a kidney transplant. Blood work, urine tests, and infectious disease screening are completed as part of the pre-transplant evaluation.Z01.812 can be used to code the encounter for these tests.Appropriate ICD codes related to the transplant evaluation would also be included.

Documentation should include the physician's order for the preprocedural laboratory tests, the specific tests performed, the test results, and the date and time of the tests. A link to the planned procedure should also be present.

** Z01.812 is generally not acceptable as a principal diagnosis in most settings.It should be used as a secondary diagnosis when the reason for the encounter is a preprocedural lab examination.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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