Since you have only one chance to report simulation per treatment course, you should nab the right code the very first time by focusing on the number of ports, treatment volumes and treatment devices.
You can choose four simulation codes from the CPT basket:
- 77280 – therapeutic radiology simulation-aided field setting; simple
- 77285 – Intermediate
- 77290 – Complex
- 77295 – 3-dimensional
Each code has both professional and technical components, so be sure to append modifier 26 (professional component) when reporting only the physician’ services. If your coding software doesn’t alert you when modifier 26 is an option, see if you can enter notes manually for a pop-up reminder.
77280 is right for a single treatment area with either a single port or parallel opposed ports and simple or no blocking, as per CPT guidelines preceding the simulation codes.
If the simulation involves three or more converging ports, two separate treatment areas, or multiple blocks, according to CPT guidelines, 77285 is the right code.
If you are to report 77290, the simulation should involve three or more treatment areas, tangential ports, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, contrast use or hyperthermia, according to CPT guidelines.
77295 calls for documentation of computer-generated 3-D reconstruction of tumor volume and surrounding critical normal tissue from CT or MRI data to prepare for therapy, as laid down in CPT guidelines.
To get more insight on CPT codes for oncology, you can register yourself for one-stop medical coding websites, where you’ll get the entire CPT code list, the latest changes, among a host of other codes.