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v1.0.0
ICD-10 Guide
ICD-10 CodesZ28.310

Z28.310

Unvaccinated for COVID-19

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

Code Description

ICD-10 Z28.310 is a billable code used to indicate a diagnosis of unvaccinated for covid-19.

Key Diagnostic Point:

Z28.310 is used to indicate that an individual has not received the COVID-19 vaccine. This code is essential for tracking vaccination status, which is a critical component of public health initiatives aimed at controlling the spread of COVID-19. Factors influencing an individual's vaccination status may include access to healthcare, socioeconomic status, education, cultural beliefs, and misinformation. Preventive care efforts focus on educating patients about the benefits of vaccination, addressing concerns, and facilitating access to vaccines. Screening for vaccination status is vital in clinical settings to identify unvaccinated individuals and provide appropriate counseling and resources. Aftercare may involve follow-up appointments to discuss vaccination options and monitor any potential side effects post-vaccination. Understanding the social determinants of health is crucial, as they significantly impact an individual's decision to receive the vaccine and their overall health outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of reasons for vaccine hesitancy (e.g., cultural, socioeconomic)
  • Need for thorough documentation of patient education and counseling
  • Potential for multiple encounters related to vaccination status
  • Variability in state and local public health guidelines

Audit Risk Factors

  • Inadequate documentation of patient education efforts
  • Failure to capture the reasons for vaccine hesitancy
  • Misuse of the code in the absence of a clear vaccination status
  • Inconsistent application of public health guidelines

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient discussions regarding vaccination, including education on benefits and risks, and any barriers faced.

Common Clinical Scenarios

Routine checkups where vaccination status is assessed, counseling sessions for vaccine hesitancy, and follow-up visits for unvaccinated patients.

Billing Considerations

Consideration of social determinants such as access to healthcare, education level, and cultural beliefs that may influence vaccination decisions.

Public Health

Documentation Requirements

Population-level data collection on vaccination rates, reasons for vaccine hesitancy, and outreach efforts.

Common Clinical Scenarios

Community vaccination drives, epidemiological studies assessing vaccination impact, and public health campaigns targeting unvaccinated populations.

Billing Considerations

Focus on health equity and addressing barriers to vaccination in underserved communities.

Coding Guidelines

Inclusion Criteria

Use Z28.310 When
  • Z codes are used to indicate a patient's health status or contact with health services
  • 310 should be used when documenting a patient's unvaccinated status for COVID
  • It is important to sequence this code appropriately, especially when used alongside other diagnosis codes related to COVID
  • 19 or preventive care
  • Payer requirements may vary, so it is essential to verify specific guidelines for coverage

Exclusion Criteria

Do NOT use Z28.310 When
No specific exclusions found.

Related CPT Codes

90460CPT Code

Immunization administration (COVID-19 vaccine)

Clinical Scenario

Used when administering the COVID-19 vaccine to a patient who was previously unvaccinated.

Documentation Requirements

Documentation of the vaccine administered, patient consent, and any counseling provided.

Specialty Considerations

Primary care providers should ensure thorough documentation of the vaccination process.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding vaccination statuses, including Z28.310, which helps in tracking public health initiatives and understanding vaccination trends.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding vaccination statuses, including Z28.310, which helps in tracking public health initiatives and understanding vaccination trends.

Reimbursement & Billing Impact

reimbursement and compliance.

Resources

Clinical References

  • •
    CDC COVID-19 Vaccination Guidance

Coding & Billing References

  • •
    CDC COVID-19 Vaccination Guidance

Frequently Asked Questions

What documentation is required for coding Z28.310?

Documentation should include the patient's vaccination status, any discussions about vaccine hesitancy, educational efforts made by the provider, and the context of the visit. This ensures compliance and supports the use of the Z code.