Oncology & Hematology Coding Alert

Lay the foundation for simulation coding perfection with these five essentials.

Who: "Only a physician with extensive knowledge of the location and extent of the patient's condition can complete" the simulation process, states CPT Assistant (October 1997).

What: Simulation allows the oncologist to establish the patient's treatment parameters, deciding treatment port size and location.

"These codes normally include the simulation aided field setting of one or more ports directed to asingle treatment volume," CPT Assistant states.

You also may see photographs in the medical record of the patient's position and blocking.

When: Simulation may occur before treatment begins or when the oncologist changes treatment fields. You should report simulation only "once per time of setup procedure," CPT Assistant states.

Where: CPT indicates the simulation may take place "on a dedicated simulator, a radiation therapy treatment unit, or diagnostic x-ray machine."

For example, the majority of Wheaton Franciscan Healthcare facilities use a dedicated simulator, says Kristie Star, CPC, with coding and compliance at the Wisconsin-based health care system.

Why: Before you code simulation for the oncologist, be sure the service is medically necessary and that the radiation oncologist ordered and documented the service.