ICD-10 Guide

Z28.2

Immunization not carried out because of patient decision for other and unspecified reason

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z28.2 is a billable code used to indicate a diagnosis of immunization not carried out because of patient decision for other and unspecified reason.

Key Diagnostic Point:

Z28.2 is used when a patient decides not to receive an immunization for reasons that are not specified in the medical record. This decision can stem from various factors, including personal beliefs, misinformation about vaccines, fear of side effects, or logistical issues such as access to healthcare services. Understanding the social determinants of health is crucial, as factors like socioeconomic status, education level, and cultural beliefs can significantly influence a patient's decision-making regarding immunizations. Preventive care is essential in public health, and the refusal of immunizations can lead to increased susceptibility to vaccine-preventable diseases, impacting both individual and community health. Coders must ensure accurate documentation of the patient's decision-making process and any discussions held regarding the benefits and risks of immunization to support the use of this code.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Variability in patient decision-making reasons
Need for thorough documentation of discussions
Potential for misinterpretation of patient intent
Influence of social determinants on health decisions

Audit Risk Factors

Inadequate documentation of patient discussions
Failure to specify the reason for refusal
Misclassification of the patient's decision
Lack of follow-up on immunization status

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient discussions regarding immunization benefits, risks, and any expressed concerns or beliefs.

Common Clinical Scenarios

Routine checkups where immunizations are recommended but declined by the patient.

Billing Considerations

Consideration of social determinants such as access to healthcare, education, and cultural beliefs that may influence the patient's decision.

Public Health

Documentation Requirements

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

Common Clinical Scenarios

Community health assessments and outreach programs aimed at increasing immunization uptake.

Billing Considerations

Focus on population health trends and the impact of vaccine hesitancy on community health.

Coding Guidelines

Inclusion Criteria

Use Z28.2 When

Z codes should be used when there is no specific diagnosis but a need to capture the patient's health status or circumstances affecting care
2 should be sequenced appropriately, often following a primary diagnosis related to the visit
Payer requirements may vary, so coders should verify specific payer guidelines regarding the use of Z codes

Exclusion Criteria

Do NOT use Z28.2 When

No specific exclusions found.

Related CPT Codes

90460CPT Code

Immunization administration

Clinical Scenario

Used when immunizations are discussed but not administered due to patient decision.

Documentation Requirements

Document the immunization discussion and patient decision.

Specialty Considerations

Primary care providers should ensure thorough documentation of the conversation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding patient decisions regarding immunizations, enabling better tracking of immunization rates and reasons for refusal.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding patient decisions regarding immunizations, enabling better tracking of immunization rates and reasons for refusal.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding patient decisions regarding immunizations, enabling better tracking of immunization rates and reasons for refusal.

Resources

Clinical References

Coding & Billing References

Frequently Asked Questions

What should I document to support the use of Z28.2?

Document the patient's expressed reasons for not receiving the immunization, any educational discussions held, and any social factors influencing their decision.

ICD-10 Z28.2 is a billable code used to indicate a diagnosis of immunization not carried out because of patient decision for other and unspecified reason.