Even after continued discussion, some parents may continue to refuse vaccines. The information and resources below describe how to code for and document discussions. Additionally, there are general strategies to consider to reduce vaccine liability for any office that administers vaccines.

How to Code for Vaccine Counseling When No Vaccine is Administered

Scenario 1
A 2-month old patient is brought in by her parents for her check-up. The patient received her Hepatitis B vaccine at birth, but since then the parents have refused vaccines. At the well-exam, the pediatrician takes the time to review what is needed and the importance of vaccines. He answers their questions and provides them with educational information on the safety of vaccines. The parents wish to defer a little longer. The baby is healthy. The physician documents 8 minutes of vaccine counseling. What can be coded?


Teaching Point: You cannot code separately for the vaccine counseling during the well child exam due to CPT rules. The counseling is considered part of the well child exam. You would use the ICD codes for parental refusal and counseling.

Scenario 2
Parents of an established 6-week-old patient are reluctant to immunize their infant. During an encounter to address parent concerns about diaper rash, the physician spends an additional 10 minutes counseling the parents about current recommendations, safety of vaccines, efficacy, and the importance of vaccines.
The parents refuse vaccines during this visit but are going to think about their decision. The physician documents the parents’ concerns and responses to the concerns, recommendations and resources provided, and plan for follow-up at the upcoming 2-month well-child visit. The time spent in vaccine counseling is also specifically documented (eg, “Spent 10 minutes discussing parents’ concerns about immunization”). Assuming that the history, examination, and medical decision making to address the diaper rash support a 99212-level E/M service, the following codes may be reported for this encounter:


Teaching Point: Modifier 25 is appended to the problem-oriented E/M code (99212) as directed by the prefatory language for codes 99401–99429. Counseling on vaccines provided by a physician or other QHCP (eg, physician assistant, nurse practitioner) is not separately reported when vaccines are administered at the same encounter. See codes 90460–90461 to report counseling

AAP Refusal to Immunize Form

Pediatricians and other health care providers may decide it is in their best interest to formally document a parent's refusal to accept vaccinations/immunizations for a minor child. This form, which should not be considered a legal document without advice from a lawyer, may be used for such documentation. This is also available as a Microsoft Word template. Additional translations to Spanish, Russian, Mandrin, Arabic and Portuguese are forthcoming.

See this AAP letter for additional background on documenting refusal of recommended childhood immunizations. Additional provider and parent resources are also available.

AAP Clinical Report

The current AAP Clinical Report Strategies for Improving Vaccine Communication and Uptake provides information about understanding and addressing parental concerns about vaccination. It can assist pediatricians with understanding vaccine development and safety monitoring processes, discusses evidenced-based communication strategies for responding to parental concerns (including the presumptive approach and motivational interviewing) and considers the option of dismissal from a practice of families which refuse vaccinations.

Additional Resources

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American Academy of Pediatrics