Radiology Coding Alert

Question: What are the requirements for reporting 77290?


Mississippi Subscriber

Answer: Complex simulation code 77290 (Therapeutic radiology simulation-aided field setting; complex) typically applies to 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 or certain brachytherapy services.

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: 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.

The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.; and Gary S. Dorfman, MD, FACR, FSIR.