Is a cone beam (77014) the same as a simple simulation (77280)?

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Michelle Ludwig
Is a cone beam (77014) the same as a simple simulation (77280)?
The following question was posed to our esteemed colleague, Dr. Bogardus:
Is a cone beam (77014) the same as a simple simulation (77280) or are these two separate charges? Can we bill for both if they are separate charges? If we can bill both, what documentation would support the billing?

77014 covers a number of procedures: It can be the technical component of an initial CT simulation, for the CT scan procedure. It can be a cone beam CT done on the treatment machine to localize a treatment area. It is not related to 77280, which is a block check simulation done on the treatment machine utilizing fluoroscopic, film, or electronic imaging. Generally, if a cone beam CT 77014 is done, it is the localizing procedure, not 77280. As with all procedures that have a billable event associated with them, a physician report is required, and this becomes your supporting documentation. ONCOCHART will generate such a document for you; otherwise, these have to be generated by the physician as narrative reports. The actual images are part of the documentation but are not acceptable at the time of an audit as the only documentation available. If the procedures are denied by an insurance company and documentation is required, a narrative procedure will be necessary.  

Carl R. Bogardus, Jr., M.D.
All of the questions and answers and more are at your fingertips if you attend one of our upcoming seminars.  To learn more about Dr. Bogardus and his radiation oncology coding seminars, visit