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ICD-10 Guide
ICD-10 CodesZ28

Z28

Immunization not carried out and underimmunization status

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 Z28 is a used to indicate a diagnosis of immunization not carried out and underimmunization status.

Key Diagnostic Point:

The ICD-10 Level 1 Category code Z28 pertains to situations where immunization has not been carried out, as well as cases of underimmunization status. This category encompasses various scenarios, including patients who have not received recommended vaccinations due to medical, personal, or logistical reasons. It is crucial for healthcare providers to identify and document these instances to ensure appropriate follow-up and preventive care measures are taken. The clinical significance of this category lies in its ability to highlight gaps in immunization coverage, which can lead to increased susceptibility to vaccine-preventable diseases, thereby impacting public health outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient immunization records
  • Need for accurate documentation of reasons for non-immunization
  • Potential for follow-up care requirements

Audit Risk Factors

  • Inadequate documentation of reasons for non-immunization
  • Failure to follow up on immunization status
  • Misclassification of underimmunization status

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Family Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related Codes

Child Codes

22 codes
Z28.0
Immunization not carried out because of contraindication
Z28.01
Immunization not carried out because of acute illness of patient
Z28.02
Immunization not carried out because of chronic illness or condition of patient
Z28.03
Immunization not carried out because of immune compromised state of patient
Z28.04
Immunization not carried out because of patient allergy to vaccine or component
Z28.09
Immunization not carried out because of other contraindication
Z28.1
Immunization not carried out because of patient decision for reasons of belief or group pressure
Z28.2
Immunization not carried out because of patient decision for other and unspecified reason
Z28.20
Immunization not carried out because of patient decision for unspecified reason
Z28.21
Immunization not carried out because of patient refusal
Z28.29
Immunization not carried out because of patient decision for other reason
Z28.3
Underimmunization status
Z28.31
Underimmunization for COVID-19 status
Z28.310
Unvaccinated for COVID-19
Z28.311
Partially vaccinated for COVID-19
Z28.39
Other underimmunization status
Z28.8
Immunization not carried out for other reason
Z28.81
Immunization not carried out due to patient having had the disease
Z28.82
Immunization not carried out because of caregiver refusal
Z28.83
Immunization not carried out due to unavailability of vaccine
Z28.89
Immunization not carried out for other reason
Z28.9
Immunization not carried out for unspecified reason

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the Z28 category is significant, as it directly relates to public health initiatives aimed at increasing vaccination rates and preventing outbreaks of vaccine-preventable diseases. By accurately coding and documenting immunization statuses, healthcare providers contribute to population health management and quality improvement measures. Administratively, tracking underimmunization can help healthcare organizations identify at-risk populations, allocate resources effectively, and implement targeted outreach programs to improve vaccination coverage, thereby enhancing overall community health outcomes.

ICD-9 vs ICD-10

The clinical impact of the Z28 category is significant, as it directly relates to public health initiatives aimed at increasing vaccination rates and preventing outbreaks of vaccine-preventable diseases. By accurately coding and documenting immunization statuses, healthcare providers contribute to population health management and quality improvement measures. Administratively, tracking underimmunization can help healthcare organizations identify at-risk populations, allocate resources effectively, and implement targeted outreach programs to improve vaccination coverage, thereby enhancing overall community health outcomes.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer and the specific services rendered, so it is essential to verify coverage policies related to immunization services. Additionally, practices should implement routine checks to identify patients who are underimmunized and ensure they are scheduled for necessary vaccinations, which can help improve billing outcomes and patient care.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for Z28

Coding & Billing References

  • •
    Official ICD-10 Guidelines for Z28

Frequently Asked Questions

What conditions are included in Z28?

Z28 includes conditions where immunizations have not been administered, such as missed vaccinations, underimmunization due to medical conditions, or personal choice not to vaccinate.

When should I use Z28 codes?

Z28 codes should be used when documenting a patient's immunization status, particularly when vaccinations are overdue or not completed, and to indicate the need for follow-up immunizations.

What documentation is required for Z28?

Documentation should include the patient's immunization history, reasons for any missed vaccinations, and any discussions held regarding the importance of immunization.