Wiki Rad/Onc therapy Boost

[serena32]

Hello all, I am in need of help! When a boost plan is done using the same data set (original CT Simulation) is there a complex sim charged out the first day of boost? Please read below....
This is what I am being told and I am trying to understand.

"Because you guys are calling boost simulations BVSs which is not correct.
Boost sims are done at the same time as their verification sim, so you choose the highest complexity and bill it. If the boost fields have complex blocking then it should be billed out as a complex sim regardless of the modality used. I don't know how else to explain it. The only time your boost simulations will be simple is when the dr. orders a re-ct and a c. sim is charged out that day and then when it is sim'd on the table (typically, a few days later) it truly is VERIFICATION ONLY-BVS because the complex sim was billed out at the time of CT(just like pt #6 I referred to above).

For boost simulations you should be calling them BBVS (boost and block verification sim) cuz these cases you are doing both at the same time. I think the documentation templates need to be updated to better reflect what is going on."

I just don't understand where the complex sim charge on first day of boost comes in when not a clinical set-up.

 

[teblizzy]

There are several types of simulation. The above statement is combining several and mixing them up. At the time of boost for anything but IMRT a plan off the original data set can be performed and billed. The computer aided simulation which takes place in dosimetry and is where the blocking is designed can be billed as a sim. A note of what happened and the DRRs etc. designed as part of the process is necessary. The level of the computer aided simulation will be based upon the level of complexity of the blocking designed. So if open field or use of asymmetrical jaws, then simple simulation. If custom complex blocking is designed, then the computer aided sim would be complex. When the patient comes back in and is imaged with films taken of every port with the designed blocking and the physician approves this prior to treatment, this is a simple verification simulation. Verification simulations happen on the treatment table and are simple, there is no other level for them.

If the physician were to order a new data set and the patient was brought back into the CT simulator (you said same data set, but I am trying to explain the other route and the statement above mentioned it) for a new scan there are two scenarios or charges here. If the set up of the patient remains the same and no contrast was given, there is no simulation as no new set up or devices were designed, only the treatment planning CT is billable. If however, the set up of the patient is changed, contrast is administered or new devices created, this is a simulation and the complexity is based on the number of areas simulated and/or use of contrast and devices. Following this the planning will depend on the orders and whether or not significant change was seen in the tumor volume and based on that planning it will determine if a computer aided sim is billable (only with 2D 77206 and 77307 codes) or something more like 3D or IMRT (cannot bill a computer aided sim with 3D or IMRT planning).

Hope this helps.