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2025 ICD-10-CM code Z91.14

Patient's other noncompliance with medication regimen.

This code was used in conjunction with other codes to specify the underlying condition and the reason for noncompliance. It is no longer valid; refer to updated ICD-10-CM codes for specific reasons for non-adherence.

Medical necessity would be established by demonstrating that the patient's non-compliance resulted in negative health outcomes (e.g., worsening of the underlying condition, increased healthcare utilization) and that efforts were made to improve adherence.

The clinical responsibility involves documenting the patient's non-compliance, attempting to understand the reasons behind it (through discussion and shared decision-making), and developing strategies to improve adherence, such as medication education, simplified regimens, or addressing social determinants of health that may contribute to non-compliance.

IMPORTANT:This code has been deleted and replaced with more specific codes to capture the reasons for non-compliance.Refer to the current ICD-10-CM for updated codes addressing specific reasons for medication non-adherence.

In simple words: This code is used when a patient doesn't follow their doctor's instructions for taking their medicine, and there's no other more specific code to describe the reason.

This ICD-10-CM code classifies instances where a patient demonstrates non-adherence to their prescribed medication regimen, excluding intentional underdosing or specific types of noncompliance already categorized by other codes.It encompasses various reasons for noncompliance not explicitly detailed elsewhere within the ICD-10-CM system. This code is for use when a more specific code is not available or applicable.

Example 1: A patient with hypertension consistently forgets to take their blood pressure medication, leading to uncontrolled blood pressure readings. The physician documents this non-compliance, discusses the importance of adherence, and provides medication reminders. The old code Z91.14 would have been used. , A patient with diabetes struggles to afford their insulin, resulting in inconsistent use. The physician documents the non-compliance, explores options for financial assistance programs, and adjusts the medication plan to maximize affordability. The old code Z91.14 would have been used., A patient with chronic pain reports experiencing side effects from their opioid medication, leading to reduced medication use without consulting their physician. The physician documents this non-compliance, addresses the reported side effects, and adjusts the medication regimen or explores alternative pain management strategies. The old code Z91.14 would have been used.

Documentation should include details of the prescribed medication regimen, evidence of non-compliance (missed appointments, medication refill patterns, lab results reflecting lack of medication effect), the physician's attempts to address the non-compliance, and any interventions or adjustments made to the treatment plan.

** Since this code has been deleted, it's crucial to review the current ICD-10-CM guidelines and use the most appropriate replacement code that specifies the reasons for the patient's non-adherence to their medication regimen.The deletion reflects a move towards more precise coding to improve data collection and analysis.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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