IV.M
Patients receiving preoperative evaluations only
For patients receiving preoperative evaluations only, sequence first a code from subcategory Z01.81, Encounter for pre-procedural examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation.
ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (effective October 1, 2025). Published by CMS and NCHS. Reproduced for reference — always verify against the official CMS release.