ICD-10 Guide

Z28.1

Immunization not carried out because of patient decision for reasons of belief or group pressure

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z28.1 is a billable code used to indicate a diagnosis of immunization not carried out because of patient decision for reasons of belief or group pressure.

Key Diagnostic Point:

Z28.1 is used when a patient decides against receiving an immunization due to personal beliefs or external group pressures. This decision can stem from various factors, including cultural beliefs, religious convictions, misinformation, or societal influences. Understanding these factors is crucial for healthcare providers, as they can significantly impact health outcomes and community immunity levels. Preventive care relies heavily on immunizations to prevent disease outbreaks, and when patients opt out, it can lead to increased susceptibility to vaccine-preventable diseases. Coders must recognize the importance of documenting the reasons behind a patient's decision, as this can inform future healthcare interactions and public health strategies. Additionally, addressing social determinants of health, such as access to information and community support, is essential in understanding and mitigating these decisions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Variety of personal beliefs influencing immunization decisions
Need for thorough documentation of patient discussions
Potential for varying interpretations of 'group pressure'
Impact of cultural and social factors on patient choices

Audit Risk Factors

Inadequate documentation of patient decision-making process
Failure to capture the specific beliefs influencing the decision
Misinterpretation of group pressure context
Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient discussions regarding immunization, including reasons for refusal and any educational efforts made.

Common Clinical Scenarios

Routine checkups where immunizations are recommended but declined, follow-up visits to discuss vaccine hesitancy.

Billing Considerations

Consider the influence of social determinants such as education level, community beliefs, and access to healthcare resources.

Public Health

Documentation Requirements

Collect data on immunization rates and reasons for refusal to inform public health initiatives.

Common Clinical Scenarios

Community health assessments, vaccination campaigns, and epidemiological studies.

Billing Considerations

Focus on population-level impacts of vaccine hesitancy and strategies to improve community immunization rates.

Coding Guidelines

Inclusion Criteria

Use Z28.1 When

Z codes should be used when the reason for the encounter is not a disease or injury but rather a social or environmental factor
1 should be sequenced appropriately, often as a secondary diagnosis, following any primary diagnosis related to the patient's health status
Payer requirements may vary, so coders should verify specific documentation needs

Exclusion Criteria

Do NOT use Z28.1 When

No specific exclusions found.

Related CPT Codes

90460CPT Code

Immunization administration

Clinical Scenario

Used when immunizations are administered during a preventive visit, but may be linked to Z28.1 if the patient refuses.

Documentation Requirements

Document the immunization attempt and the patient's refusal.

Specialty Considerations

Primary care providers should ensure thorough documentation of discussions around vaccine hesitancy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding reasons for immunization refusal, enabling better tracking of vaccine hesitancy and its impact on public health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding reasons for immunization refusal, enabling better tracking of vaccine hesitancy and its impact on public health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding reasons for immunization refusal, enabling better tracking of vaccine hesitancy and its impact on public health.

Resources

Clinical References

Coding & Billing References

Frequently Asked Questions

What should I document if a patient refuses vaccination?

Document the patient's reasons for refusal, any educational materials provided, and the discussion held regarding the importance of vaccination. This helps in understanding the patient's perspective and may inform future healthcare interactions.

ICD-10 Z28.1 is a billable code used to indicate a diagnosis of immunization not carried out because of patient decision for reasons of belief or group pressure.