In simple words: This code is used when a healthcare provider cannot track a patient's adherence to recommended treatments for specific reasons, such as a terminal illness, patient refusal, or financial barriers.

Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)

Example 1: A patient diagnosed with terminal cancer with a life expectancy of 3 months declines further treatment. The physician uses G8854 to document the reason for not reporting adherence to therapy., A patient with severe depression cannot afford the prescribed medication due to lack of insurance. The physician uses G8854 to document the financial barrier to therapy adherence., A patient receiving therapy for substance abuse misses multiple appointments and does not return for follow-up. The physician uses G8854 to document the lack of patient follow-up as the reason for not reporting adherence.

The medical record must clearly document the specific reason(s) for not objectively reporting adherence to evidence-based therapy. The documentation should include details about the patient's condition, the recommended therapy, and the barrier to adherence.

** This code is intended for use in programs focused on quality improvement and value-based care. It helps to identify and track patients who are not adhering to evidence-based therapies due to various reasons.