Fam Pract Manag. 2017 Nov-Dec;24(6):34.

Author disclosure: no relevant financial affiliations disclosed.

Immunization refusal


Which ICD-10 code should I assign to indicate a patient's immunization refusal?


If a patient refuses immunization due to religious belief or group pressure, assign code Z28.1, “Immunization not carried out because of patient decision for reasons of belief or group pressure.” If the patient refuses for another reason, such as the discomfort of injections, report code Z28.21, “Immunization not carried out because of patient refusal.” When a parent or other caregiver refuses immunization for a child, report code Z28.82, “Immunization not carried out because of caregiver refusal.”

CPT codes 99381 – 99397 for initial or periodic comprehensive preventive medicine visits include all counseling, anticipatory guidance, and risk-factor reduction interventions provided at the time of the exam. Note that immunization counseling not provided in conjunction with a preventive medicine exam and taking at least eight minutes may be reported with preventive medicine counseling and risk-factor reduction codes 99401 – 99404. Preventive medicine counseling codes may be reported alone or in conjunction with a code for a significant, separately identifiable E/M service, to which you would append modifier 25.

For quality measurement, payers may require reporting HCPCS code G8483 when a flu shot is not administered for reasons documented by the clinician.

Care planning and chronic care management


Can we bill HCPCS code G0506, “Comprehensive assessment of and care planning for patients requiring chronic care management services,” in the same 30-day period as chronic care management (CCM) codes 99490, 99487, and 99489?


Yes. G0506 is an add-on code that may be reported in addition to the code for an initiating visit when the billing provider personally performs assessment and care planning beyond the usual effort of the initiating visit. Initiating visits

About the Author

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Reviewed by the FPM Coding & Documentation Review Panel: Kenneth Beckman, MD, MBA, CPE; Robert H. Bösl, MD, FAAFP; Marie Felger, CPC, CCS-P; Thomas A. Felger, MD, DABFP, CMCM; Emily Hill, PA-C; Joy Newby, LPN, CPC; and Susan Welsh, CPC, MHA.

Author disclosure: no relevant financial affiliations disclosed.


Send questions and comments to, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.


Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz


Nov-Dec 2018

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now