How To Use CPT Code 77280

CPT 77280 describes the process of therapeutic radiology simulation-aided field setting for radiation treatment. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 77280?

CPT 77280 is used to describe the process of therapeutic radiology simulation-aided field setting for radiation treatment. This code is used when the provider uses a simulator or other imaging modality to determine the size and location of ports to be used for radiation therapy. The simulation can be classified as simple, intermediate, or complex based on certain criteria such as the use of particle therapy, complex blocking, or the number of treatment areas involved.

2. Official Description

The official description of CPT code 77280 is: ‘Therapeutic radiology simulation-aided field setting; simple.’

Simulation is the process of defining relevant normal and abnormal target anatomy, and acquiring the images and data necessary to develop the optimal radiation treatment process for the patient. A simulation is defined as complex if any of these criteria are met: particle, rotation or arc therapy, complex or custom blocking, brachytherapy simulation, hyperthermia probe verification, or any use of contrast material. If a simulation does not meet any of these criteria, the complexity is defined by the number of treatment areas: one treatment area is simple, two treatment areas are intermediate, and three or more treatment areas are complex.

3. Procedure

1. The provider performs a therapeutic radiology simulation-aided field setting to determine the size and location of ports for radiation therapy.
2. The provider uses a simulator or other imaging modality, such as an X-ray machine or CT scanner, to define, image, and mark the radiation therapy fields.
3. The simulation can be classified as simple, intermediate, or complex based on certain criteria.
4. In a simple simulation, the provider determines the size and location of a port in a single anatomic location or two parallel opposite ports.
5. In an intermediate simulation, the provider determines the size and location of ports in two separate treatment areas.
6. In a complex simulation, the provider determines the size and location of ports in three or more treatment areas, or any number of treatment areas if certain criteria are met.

4. Qualifying circumstances

CPT 77280 can be used when the provider performs a therapeutic radiology simulation-aided field setting for radiation treatment. The complexity of the simulation is determined by certain criteria, such as the use of particle therapy, complex blocking, or the number of treatment areas involved. The number of treatment areas can range from one to three or more, depending on the complexity of the simulation.

5. When to use CPT code 77280

CPT code 77280 should be used when the provider performs a therapeutic radiology simulation-aided field setting for radiation treatment. This code is specifically used for a simple level of simulation, where the provider determines the size and location of ports in a single anatomic location or two parallel opposite ports. If the simulation involves two separate treatment areas, CPT code 77285 should be used. For a simulation with three or more treatment areas, CPT code 77290 is appropriate.

6. Documentation requirements

To support a claim for CPT code 77280, the provider must document the following information:

• The reason for the therapeutic radiology simulation-aided field setting
• The specific size and location of the ports determined during the simulation
• The complexity level of the simulation (simple, intermediate, or complex)
• The date and duration of the simulation
• Any additional relevant details or findings from the simulation
• The provider’s signature

7. Billing guidelines

When billing for CPT code 77280, ensure that the provider performs a therapeutic radiology simulation-aided field setting for radiation treatment. Use the appropriate CPT code based on the complexity level of the simulation. If reporting only the provider’s services, append modifier 26 to indicate the professional component. If reporting only the technical component, append modifier TC to the radiology code. However, note that payer policy may exempt hospitals from appending modifier TC. If the provider renders both the professional and technical components, do not append any modifiers.

8. Historical information

CPT code 77280 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A radiation oncologist performs a therapeutic radiology simulation-aided field setting to determine the size and location of ports for radiation therapy in a patient with breast cancer.
2. A radiologist uses a simulator to define and mark radiation therapy fields for a patient with lung cancer, ensuring precise targeting of the tumor.
3. A radiation therapist performs a simple simulation to determine the size and location of a port for radiation therapy in a patient with prostate cancer.
4. A radiation oncologist conducts a therapeutic radiology simulation-aided field setting to determine the size and location of ports for radiation therapy in a patient with brain tumor.
5. A radiologist uses a CT scanner to define and mark radiation therapy fields for a patient with head and neck cancer, optimizing the treatment plan.
6. A radiation therapist performs an intermediate simulation to determine the size and location of ports in two separate treatment areas for a patient with cervical cancer.
7. A radiation oncologist conducts a complex simulation to determine the size and location of ports in three treatment areas for a patient with multiple bone metastases.
8. A radiologist uses a simulator to define and mark radiation therapy fields for a patient with liver cancer, considering the complexity of the treatment areas.
9. A radiation therapist performs a simple simulation to determine the size and location of a port for radiation therapy in a patient with skin cancer.
10. A radiation oncologist conducts a therapeutic radiology simulation-aided field setting to determine the size and location of ports for radiation therapy in a patient with rectal cancer.