Oncology & Hematology Coding Alert

Question: For therapeutic radiology simulation-aided field setting, it seems that we report 77290 (complex) at least twice as much as we report the other codes (77280, 77285 and 77295). Would you explain the requirements for 77290 so we can be sure we aren't setting ourselves up for disaster if we get audited?


Arizona Subscriber

Answer: Benchmarking data indicate that you're right on the money if you're reporting 77290 (Therapeutic radiology simulation-aided field setting; complex) more than the other codes. While individual payer guidelines vary, you should see at least one of the following documented in the simulation note before choosing 77290.

You may see a record of three or more treatment areas. Your oncologist may document highly complex blocking, special wedges or compensators, custom shielding blocks, complex immobilization, or multi-leaf collimation. He may also mention if this is stereotactic or arc therapy.

You should report 77290 if you see documentation of brachytherapy source verification (either radioactive or dummy sources) or hyperthermia probe verification.

If your oncologist reports any use of contrast materials, with or without fluoroscopy, report 77290. Contrast materials include agents introduced into a body cavity or organ or IV contrast, but they don't include radiopaque metallic wires, markers or rods.

You should also look to 77290 if you see a report of oblique fields or rotational or special beam considerations, such as any electron, neutron or proton field.

Remember: Don't count on a single word to tell you a simulation is complex - it's the inclusion of all information in the simulation note that provides a complex picture of the patient simulation.

Watch for: Tangential ports usually merit 77290, but some payers require you to report 77285 (Therapeutic radiology simulation-aided field setting; intermediate) for tangential ports without devices or with one pair of non-custom wedges.