Oncology & Hematology Coding Alert

Question: Our clinic has heard a lot about groups getting audited for block verification simulation. Now I'm afraid to use the code at all. What is the risk with using this code?

Georgia Subscriber

Answer: Block verification simulation 77280 (Therapeutic radiology simulation-aided field setting; simple) is one of the most highly audited codes in radiation oncology, so your caution is not misdirected. Audits of 77280 generally occur when practices use it indiscriminately. There are, however, legitimate and defensible opportunities for using this code. Your documentation must include the radiation oncologist's order for the block verification simulation and the medical necessity for this service. Remember that not every setup requires a block check simulation. The physician usually performs it only if it's a complicated field, the physician can document a specific problem encountered during treatment planning, or the port films do not properly align.

Don't pay separately for this service when performed on the treatment machine with "port films" because, according to the payers, port films and block verification simulation serve the same purpose. Both modalities verify correct placement of fields and treatment device prior to the initiation of therapy, they contend. Given these payer assumptions, when selecting 77280 you should pay extremely close attention to details, such as the physician order for verification simulation and the documented necessity for this service in the simulation note. Make sure these details back up your choice.

Remember also that payers require direct physician supervision when reporting any simulation procedure. You may not convince all payers even if 77280 is correct, so report the code with caution.

Answers to the Reader Questions and You Be the Coder were reviewed by Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans; and Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.