How to code for immunization refusal

Documenting and coding for patients' immunization refusal may be necessary for quality initiatives and continuity of care. Several HCPCS and ICD-10 codes are relevant and may be used appropriately depending on specific payer and practice guidance for coding immunization refusal:

• For influenza vaccine refusal when the reason is documented, HCPCS code G8483, "Influenza immunization was not administered for reasons documented by clinician."

• For pneumococcal vaccine refusal when the reason is documented, HCPCS code G8866, "Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine."

• For immunization refusal due to religious belief or group pressure, ICD-10 code Z28.1, “Immunization not carried out because of patient decision for reasons of belief or group pressure.”

• For immunization refusal due to another reason, such as the discomfort of injections, ICD-10 code Z28.21, “Immunization not carried out because of patient refusal.”

• For immunization refusal by a parent or other caregiver for a child, ICD-10 code Z28.82, “Immunization not carried out because of caregiver refusal.”

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Posted on Oct 04, 2018 by FPM Editors