ICD-10 Guide

Z28.29

Immunization not carried out because of patient decision for other reason

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z28.29 is a billable code used to indicate a diagnosis of immunization not carried out because of patient decision for other reason.

Key Diagnostic Point:

Z28.29 is used when a patient decides not to receive an immunization for reasons other than medical contraindications or lack of availability. This decision can stem from various factors, including personal beliefs, misinformation about vaccines, cultural influences, or fear of side effects. Understanding the social determinants of health is crucial, as these factors significantly impact a patient's health status and their interactions with healthcare services. Preventive care, particularly immunizations, plays a vital role in public health by preventing disease outbreaks and promoting community immunity. Coders must accurately document the reasons for the patient's decision, as this information is essential for understanding vaccination trends and addressing barriers to immunization in specific populations.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Variety of patient reasons for refusal, requiring detailed documentation.
Need for clear communication between healthcare providers and patients.
Potential for misinterpretation of patient intent without proper documentation.
Influence of cultural and social factors on patient decisions.

Audit Risk Factors

Inadequate documentation of patient reasons for refusal.
Failure to capture the context of the patient's decision.
Misuse of the code when a medical contraindication exists.
Inconsistent coding practices across different 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 by the patient.

Billing Considerations

Consideration of social determinants such as access to information and cultural beliefs influencing patient decisions.

Public Health

Documentation Requirements

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

Common Clinical Scenarios

Community health assessments and vaccination campaigns where understanding refusal rates is critical.

Billing Considerations

Focus on population health trends and addressing barriers to immunization in specific communities.

Coding Guidelines

Inclusion Criteria

Use Z28.29 When

Z codes should be used when there is no active disease or injury, and the patient decision is documented
When coding Z28
29, ensure that the patient's decision is clearly articulated in the medical record
This code should be sequenced appropriately, often following the primary diagnosis related to the visit
Payer requirements may vary, so it's essential to verify specific documentation needs

Exclusion Criteria

Do NOT use Z28.29 When

No specific exclusions found.

Related CPT Codes

90460CPT Code

Immunization administration

Clinical Scenario

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

Documentation Requirements

Document the discussion with the patient regarding the immunization.

Specialty Considerations

Primary care providers should ensure thorough documentation of patient education efforts.

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 vaccination trends and patient education efforts.

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 vaccination trends and patient education efforts.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding patient decisions regarding immunizations, enabling better tracking of vaccination trends and patient education efforts.

Resources

Clinical References

•
CDC Immunization Guidelines

Coding & Billing References

•
CDC Immunization Guidelines

Frequently Asked Questions

What should I document if a patient refuses an immunization?

Document the specific reasons for the patient's refusal, any educational efforts made, and the patient's understanding of the risks and benefits of immunization.

ICD-10 Z28.29 is a billable code used to indicate a diagnosis of immunization not carried out because of patient decision for other reason.