Complete knowledge of ICD-10-CM coding for immunizations means knowing how to code both when an immunization occurs and when it does not. Ready to see if you’ve mastered the ICD-10-CM codes for these encounters? Let’s go!
Choose Your Answers to These ICD-10-CM Questions
Q1. What does the code-level note with Z23 (Encounter for immunization) in the ICD-10-CM tabular list instruct you to “Code first”?
Q2. Which reason for not carrying out an immunization is NOT covered under Z28.0-?
A. acute illness
B. immune compromised state
C. patient choice based on group pressure
Q3. Which ICD-10-CM code is appropriate for documentation of lapsed immunization schedule status?
Q4. Which code represents parent refusal of an immunization for the patient?
Q5. Is there a code to report if the patient has had a disease and that’s why the provider does not administer an immunization?
Check Your Answers Here
A1. You should sequence the ICD-10-CM code for “any routine childhood examination” before Z23.
A2. The answer is C. patient choice based on group pressure. When that’s the reason for a patient not getting a vaccine, use Z28.1 (Immunization not carried out because of patient decision for reasons of belief or group pressure). Under Z28.0- (Immunization not carried out because of contraindication), you’ll find these codes and descriptors:
- 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).
A3. The correct code is Z28.3 (Underimmunization status). Code-level notes with this code in the ICD-10-CM Tabular list show this code is appropriate for:
- Delinquent immunization status
- Lapsed immunization schedule status.
A4. Code Z28.82 (Immunization not carried out because of caregiver refusal) is appropriate when immunization is not carried out because of parent refusal, according to a code-level note in ICD-10-CM. Bonus tip: There’s an Excludes1 note with this code pointing you to Z28.1 for “immunization not carried out because of caregiver refusal because of religious belief.”
A5. Yes, ICD-10-CM provides Z28.81 (Immunization not carried out due to patient having had the disease).
What About You?
How did you do? Do you have coding for immunizations (and not carrying out immunizations) down cold? Or do you worry you’ll miss one of the CPT®, HCPCS, or ICD-10-CM codes that different encounters may require?