Use of Z91A98 Caregiver's noncompliance with patient's other medical treatment and regimen
We received a vendor recommendation to code Z91A98 "Caregiver's noncompliance with patient's other medical treatment and regimen for other reason" on an infant whose parents declined everything (eye ointment, Vitamin K and Hep B vaccine).
After lots of discussion, CDI felt that it was appropriate to code because there is a Z code that captures refusal of vaccines we code routinely, but that code does not include non-vaccines (like vitamin K). CDI felt the risk of not receiving vitamin K carries significant risk for the first 6 months of life, and no elective procedures would be performed like frenotomy or circumcision. It also carries some SDOH weight as many Pediatricians will not see baby if they have not received vitamin K. The codebook states this code includes caregiver non-compliance with other medications for financial or other reasons. There are no excludes notes when adding both Z codes (for the vaccine refusal).
Coding felt that vitamin K/eye ointment are prophylactic measures and not an actual medication regimen or necessary treatment. They felt this code is not appropriate because parents have a right to refuse recommendations and this does not constitute non-compliance, that this is no different than declining a circumcision.
We have submitted the question Coding Clinic, but would love any guidance or insight you all could offer on this particular code.