Oncology & Hematology Coding Alert

Question: Our oncologists perform simulations on patients before radiation treatments, but some of our coders have trouble keeping the complex sim coding requirements straight. What exactly constitutes complex simulation, and how should we report it?

Virginia Subscriber

Answer: Physicians most often perform complex simulations on patients with three or more treatment areas who need either rotation or arc therapy - or on patients who need highly complex blocking. When your oncologist performs complex simulation, you should report 77290 (Therapeutic radiology simulation-aided field setting; complex).
 
Coders most commonly report 77290 for prostate seed implants. However, you can also use a complex simulation code when the physician confirms a hyperthermia probe or verifies a brachytherapy source.
 
Remember: On the claim, include a simulation note for each complex simulation the oncologist performs. A simulation note documents each simulation on a patient. Each simulation note should include:
  the date of service
  the reason for the simulation (e.g., initial simulation, block check and subsequent simulations as a result of changes in field setting)
  a procedure summary that includes patient position, identification of field location, and critical structures blocked
  a description of any customized immobilization equipment used
  a summary of any fluoroscopy and/or contrast used.
 
 - Clinical and coding expertise for this issue of Oncology Coding Alert provided by Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.