Oncology & Hematology Coding Alert

Question: How should I report 77280?

Oklahoma Subscriber Answer: Because payers often audit practices that indiscriminately report block-verification code 77280 (Therapeutic radiology simulation-aided field setting; simple), radiation oncology practices should use the code with caution.
 
To report 77280 with confidence, remember that most radiation oncologists perform block verification simulation after the initial simulation to verify the accuracy of complex blocks prior to the start of treatment. Make sure the physician documents the order for block verification and the appropriate ICD-9, such as 185 (Prostate cancer), to prove medical necessity.
 
Sometimes when radiation oncology practices report the code appropriately, payers still deny the claim. When it's performed on the treatment machine, many payers lump this service in with "port films" because they believe that both port films and a block verification simulation serve the same purpose. They believe that both modalities verify correct placement of fields and treatment devices prior to the initiation of therapy.
 
Because insurers lump the block verification with port films, you should pay close attention to details such as the physician order for verification simulation and documented medical necessity for this service in the simulation note. Remember that Medicare and private payers require direct physician supervision when reporting any simulation procedure. Also, you should check with your insurer for its 77280 policy.