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 misplaced. Audits of this code generally arise when it is used indiscriminately in a practice. However, there are legitimate and defensible opportunities to use this code. Block verification simulation is typically performed after the initial simulation to verify the accuracy of complex blocks prior to the start of treatment. The radiation oncologist's order for the block verification simulation and the medical necessity for this service must be documented in the simulation note. It is also important to remember that not every setup requires a block check simulation. It's generally only performed for a complicated field, if the physician can document a specific problem encountered during treatment planning, or if the port films do not align properly.                                                                           

Even when billed appropriately, 77280 can cause reimbursement blues with many payers. When 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.            

As a result of this payer assumption, you should pay extremely 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 direct physician supervision is required when reporting any simulation procedure. Even so, you will not prevail with all payers, so caution remains a wise choice.