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v1.0.0
ICD-10 Guide
ICD-10 CodesZ28.0

Z28.0

Immunization not carried out because of contraindication

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z28.0 is a billable code used to indicate a diagnosis of immunization not carried out because of contraindication.

Key Diagnostic Point:

Z28.0 is used when an immunization is not administered due to a contraindication, which may include medical conditions, allergies, or other health factors that pose a risk to the patient. This code highlights the importance of understanding the patient's health status and social determinants that may influence their ability to receive vaccinations. Factors such as access to healthcare, socioeconomic status, and education can impact immunization rates. Preventive care is crucial in public health, and documenting contraindications ensures that healthcare providers can track immunization coverage and identify populations at risk. This code is essential for preventive care documentation, as it helps in understanding barriers to immunization and aids in developing targeted public health interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for thorough documentation of contraindications
  • Variability in contraindications based on individual health conditions
  • Potential for misinterpretation of patient history
  • Requirement for clear communication between healthcare providers

Audit Risk Factors

  • Inadequate documentation of the contraindication
  • Failure to specify the nature of the contraindication
  • Misuse of the code when immunization was simply refused
  • Lack of follow-up documentation on the patient's health status

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document the specific contraindication, patient history, and any discussions regarding vaccination.

Common Clinical Scenarios

Routine checkups where immunizations are recommended but not administered due to medical history.

Billing Considerations

Consider social determinants such as access to care and patient education regarding immunizations.

Public Health

Documentation Requirements

Collect data on population-level contraindications and vaccination rates.

Common Clinical Scenarios

Community health assessments identifying barriers to immunization.

Billing Considerations

Focus on tracking health disparities and developing outreach programs.

Coding Guidelines

Inclusion Criteria

Use Z28.0 When
  • Z codes are used when a patient encounters healthcare services for reasons other than a current illness or injury
  • 0 should be sequenced appropriately, often following the primary diagnosis that necessitated the visit
  • Payer requirements may vary, so it's essential to check specific guidelines for documentation and coding

Exclusion Criteria

Do NOT use Z28.0 When
No specific exclusions found.

Related CPT Codes

90460CPT Code

Immunization administration

Clinical Scenario

Used when documenting the administration of vaccines, which may be accompanied by Z28.0 if not administered.

Documentation Requirements

Document the reason for not administering the vaccine alongside the CPT code.

Specialty Considerations

Primary care providers should ensure clear communication with patients regarding contraindications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding, allowing for better tracking of immunization contraindications and enhancing public health data collection.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding, allowing for better tracking of immunization contraindications and enhancing public health data collection.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding, allowing for better tracking of immunization contraindications and enhancing public health data collection.

Resources

Clinical References

  • •
    CDC Immunization Guidelines

Coding & Billing References

  • •
    CDC Immunization Guidelines

Frequently Asked Questions

What should I document when using Z28.0?

Document the specific contraindication, any relevant patient history, and discussions about vaccination options. This ensures accurate coding and supports preventive care efforts.