How To Use HCPCS Code G8855

HCPCS code G8855 describes the situation where adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), and the reason for not assessing adherence is not given. This code is used to indicate that the healthcare provider did not evaluate the patient’s adherence to therapy on an annual basis using an objective informatics system or self-reporting, and there is no documented reason for not doing so.

1. What is HCPCS G8855?

HCPCS code G8855 is a specific code used in medical coding to identify the situation where adherence to therapy was not assessed annually through an objective informatics system or self-reporting, and the reason for not assessing adherence is not given. This code helps in documenting and tracking instances where healthcare providers did not evaluate the patient’s adherence to therapy on an annual basis using an objective informatics system or self-reporting.

2. Official Description

The official description of HCPCS code G8855 is “Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given.” The short description for this code is “Ther not assessed annually.”

3. Procedure

1. The healthcare provider should review the patient’s medical records and treatment plan to determine if adherence to therapy was assessed within the past year.
2. If there is no documentation of adherence assessment, the provider should check if an objective informatics system was used to assess adherence. If not, the provider should determine if self-reporting was used as an alternative.
3. If an objective informatics system was used, the provider should ensure that the assessment was conducted at least annually.
4. If self-reporting was used, the provider should verify that the patient’s self-reporting was documented and assessed within the past year.
5. If there is no documentation of adherence assessment through an objective informatics system or self-reporting, the provider should indicate the reason for not assessing adherence.

4. When to use HCPCS code G8855

HCPCS code G8855 should be used when the healthcare provider did not assess the patient’s adherence to therapy at least annually through an objective informatics system or self-reporting, and there is no documented reason for not assessing adherence. This code is used to indicate instances where adherence assessment was not performed as required.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8855, healthcare providers need to ensure that the medical records clearly document the lack of adherence assessment and the absence of a documented reason for not assessing adherence. The documentation should include details of the therapy being assessed, the timeframe within which the assessment should have been conducted, and any relevant patient information that may impact adherence assessment.

6. Historical Information and Code Maintenance

HCPCS code G8855 was added to the Healthcare Common Procedure Coding System on January 01, 2012. The code has an action code of C, indicating a change in the long description of the procedure or modifier code. The action effective date is January 01, 2024. As of now, there have been no maintenance actions taken for this code, as indicated by the pricing indicator code 00, which means the service is not separately priced by Part B.

7. Medicare and Insurance Coverage

HCPCS code G8855 is not separately priced by Medicare, as indicated by the pricing indicator code 00. This means that the service is not covered or bundled by Medicare and is not separately reimbursed. The multiple pricing indicator code for this code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G8855 should be billed:

1. A patient with a chronic condition is receiving medication therapy, but the healthcare provider did not assess the patient’s adherence to the prescribed medication on an annual basis using an objective informatics system or self-reporting, and there is no documented reason for not assessing adherence.
2. A patient with diabetes is receiving insulin therapy, but the healthcare provider did not evaluate the patient’s adherence to the insulin regimen on an annual basis using an objective informatics system or self-reporting, and there is no documented reason for not assessing adherence.
3. A patient with hypertension is prescribed antihypertensive medication, but the healthcare provider did not assess the patient’s adherence to the medication on an annual basis using an objective informatics system or self-reporting, and there is no documented reason for not assessing adherence.
4. A patient with asthma is using an inhaler for maintenance therapy, but the healthcare provider did not evaluate the patient’s adherence to the inhaler regimen on an annual basis using an objective informatics system or self-reporting, and there is no documented reason for not assessing adherence.
5. A patient with a mental health condition is receiving psychotherapy, but the healthcare provider did not assess the patient’s adherence to the therapy sessions on an annual basis using an objective informatics system or self-reporting, and there is no documented reason for not assessing adherence.