Claims about US medical codes for unvaccinated are misleading
Social media posts claim the US government is using codes from doctors to track people who have not been vaccinated against Covid-19. This is misleading; under federal law, individuals must consent to the release of their medical records -- and the codes are part of an international system that makes anonymized health data available for research.
"ICD-10 is that our new label so we can be tracked?" asks a February 5, 2023 Instagram post sharing a TikTok video.
The narrator in the clip says: "Any time you go to the doctor -- you have a physical, you have your blood drawn -- they ask you, 'Are you vaccinated?' And if you say no, you become an ICD-10 so you can be tracked."
The claim has also circulated on Instagram, where a February 6 post shares a video of Fox News host Laura Ingraham in a segment with a chyron that says: "EXPOSED: CDC's plot to track the unvaccinated."
"So it's not just a tracking of the unvaccinated, which is ridiculous. If you thought getting one or even two shots was going to shield you from being surveilled or tracked -- medical 'Big Brother' looking over your shoulder -- you were wrong," Ingraham says in the clip.
Screenshot of an Instagram post taken February 12, 2023
Screenshot of an Instagram post taken February 12, 2023
The claims stem from an article that National File, a conservative news site, published February 2, 2023 with the headline: "EXCLUSIVE: The Federal Government Is Tracking Unvaccinated People Who Go To The Doctor And To The Hospital Due to CDC-Designated Surveillance Program."
Similar allegations have circulated widely on Facebook, Instagram, and YouTube in English and French. Thousands of Twitter users have shared the National File's article -- including those whom AFP has previously fact-checked for sharing vaccine misinformation, such as Robert Malone.
Health care providers have used codes to track patients' Covid-19 vaccination status since 2022. But they were not "quietly" implemented, as the posts suggest -- and experts say the data is anonymized for research.
"Medical information is protected, private information, so just like whether someone has cancer or HIV or diabetes, vaccination status is not public information," said Karen Joynt Maddox, co-director of the Center for Health Economics and Policy at Washington University in St Louis, in a January 31 email.
What are ICD codes?
The International Classification of Diseases (ICD) is a global standard for "the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or regions and at different times," according to the World Health Organization (WHO).
The ICD provides "a format for reporting causes of death on the death certificate," the US Centers for Disease Control and Prevention (CDC) says on its website.
The system enables tracking everything from broad diagnoses such as Huntington's disease to far more granular symptoms, including "atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm."
The 10th version of the ICD introduced "Z" codes to capture "factors that influence health status," the US Centers for Medicare and Medicaid Services says online.
The WHO adopted an 11th version of the ICD in 2022. However, the US still uses ICD-10, according to Kent Moore, senior strategist of physician payment at the American Academy of Family Physicians (AAFP).
The US Department of Health and Human Services (HHS) has since 2015 required all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to use the ICD-10 codes.
"The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other individually identifiable health information," HHS says on its website -- particularly that collected by health care providers and health insurance companies that use electronic records.
The rule "gives individuals rights over their protected health information," according to HHS. While epidemiologists and public health scientists regularly use ICD-10 codes to study diseases and care outcomes, the data is anonymized.
The WHO introduced Code Z28 in 2015 to record reasons for lack of vaccination -- including shots routinely recommended to children, according to a 2016 newsletter from the American Academy of Pediatrics. The code has previously been the subject of misinformation.
The three codes referenced in the social media posts -- "Unvaccinated for Covid-19" (Z28.310), "Partially vaccinated for Covid-19" (Z28.311) and "Other underimmunization status" (Z28.39) -- were proposed and created by the National Center for Health Statistics within the CDC.
The US has used the codes since April 1, 2022, when multiple government agencies announced their implementation. They do not apply to patients whom health care providers have determined are ineligible for Covid-19 vaccines.
"Those were created specifically for the US version of ICD-10 because of the interest in being able to collect that risk factor," said Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association. "Other countries may have adopted something similar, but it's not in the international version."
She said the codes are similar to those for other social determinants of health that physicians and public health professionals examine, including alcohol and tobacco use.
"This is just like every other kind of risk factors that are collected to get a fuller picture of the patient's health status and what their risks might be, just like smoking," Bowman said February 17. "That's really the reason for creating this code, because the lack of being vaccinated is a risk factor for being hospitalized, dying, having more complications from Covid."
Similar to other ICD Codes, Bowman said any data shared with researchers is anonymized.
"Even the CDC doesn't have specific, personally identifiable information about your vaccination status," she said.
AAFP's Moore said he is "not aware of any consequences to the patient associated with reporting Z28.310 or Z28.311" -- nor would the code be associated with public documents such as a passport.
AFP asked the CDC about the Z codes, but a response was not forthcoming.
All of AFP's reporting on vaccine misinformation is available here.