June 2008 Coding Tip (View More 2008 Coding Tips)

Can we bill for a simulation (77280-77290) for patient set-up and a CT (77014) for treatment planning on the same date of service?

Yes, the determination of patient position, construction of immobilization devices, reference or isocenter marking, etc. is billed as a simulation. This set-up simulation occurs along with the acquisition of CT images (77014), and in order to be billed must be clearly documented. This work may be occurring in the radiation therapy department before going to radiology for the CT, or the entire procedure may be occurring in either radiology or the radiation therapy department. The complexity level of the simulation is dependent on the inclusion of custom immobilization devices and/or the administration of contrast. Without any custom immobilization devices or contrast media the simulation will be considered simple (77280); custom immobilization or contrast media will elevate the complexity level of the simulation to complex (77290).