Oncology Coding Article – Coding and Billing of Block Verification Simulations

Specialty Groups — Oncology

Medical Oncology Code Changes

ACOA Coding Minute

There are a number of myths regarding the coding and billing of block verification simulations, and it is important to note that the medical record should include the following when this service is billed:

  • An order from the radiation oncologist for a verification simulation. The radiation oncologist is responsible for determining the procedures necessary for patient treatment, and it is essential that both professional and facility billing reflect the type and level of service performed. It is not appropriate for the facility to bill the initial set of port films as a verification simulation without a physician order for this service.

  • The medical necessity for a verification simulation should be documented in the medical record. Most payors indicate that an initial set of port films are necessary to ensure that all treatment devices are in place, patient positioning is correct, etc. If a verification simulation is needed in place of port films, the medical indication for this service should be included in the medical record.
  • The verification simulation should be documented with a simulation note in the same manner as any other simulation service.

Providing that information in the patient medical record supports the need for, and performance of, a verification simulation, there should be no difficulty receiving reimbursement for this service.

Cindy C. Parman, CPC, CPC-Hcparman-8112892
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.