Oncology & Hematology Coding Alert

Question: What exactly constitutes complex simulation, and how should we report it?

California Subscriber

Answer: When your documentation shows complex simulation, you should report 77290 (Therapeutic radiology simulation-aided field setting; complex).
 
You-re most likely to see complex simulation on patients with three or more treatment areas who need either rotation or arc therapy. You may also see this service for patients who need highly complex blocking.
  
Brachytherapy notes: You most commonly report 77290 for prostate seed implants, but you can also use the complex-simulation code when the physician confirms a hyperthermia probe or performs a simulation to develop brachytherapy isodose curves. 
 
Documentation do-s: You should look for a simulation note for each complex simulation the oncologist performs. A simulation note documents each simulation on a patient and should include:

   - the date of service
   - the reason for the simulation (for example, initial simulation, block check, and subsequent simulations as a result of changes in field setting)
   - a procedure summary that includes information on 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.