To be clear you are not charging the patient for a service related to the provider's offer of the vaccine, correct? You indicated in your original message that claims are receiving denials when you use DX Z28.21, so I'm confused on what you are submitting to the payer that they are denying.
- Are you listing this DX as the primary DX on the claim?
- Or are linking it to billed service in a second, third or fourth position on the claim line?
Can you provide some redacted examples of claims that you submitted with Z28.21 which were denied by the insurance company as well as what the denial reason was for the service?
FYI:
Per the ICD-10 Guidelines for Chapter 21 Factors Influencing Health Status and Contact with Health Services (Z00–Z99), Category 14-Miscellaneous Z codes states the following:
So basically Z28.21 is an informational code that is optional and should not be used to bill for services, unless your state's Medicaid program has instructions to use this code for billing services.
Also, if your provider participates in some type of payer program which provides additional reimbursement or bonuses linked to their patient's health outcomes, you may need to report this code if there are specific metrics in the provider's contract related to the vaccination rates of the patients covered by the insurance company.
I work for an insurance company, and we do have certain programs surrounding increasing the vaccination rates of patients covered by our plans which will provide a bonus or increase the provider's contract allowances if they meet certain metrics. So, providers would want to submit claims with Z28.21 on them as an informational only code to indicate they offered the vaccine and the patient declined. The provider should receive credit for trying to improve their patient's vaccination rates and not lose out on the additional reimbursement due the patient's decision to decline the vaccine.