Practice Quiz

Medical Coding

Category - Coding Guidelines

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A 32-year-old woman with repeat urinary tract infections presented to the office with painful urination. Suspecting another UTI, the physician sent a urine sample to the lab to identify the bacteria causing the infection. The physician’s office billed for the laboratory service themselves, even though they sent the sample to an outside lab for the test. What modifier is appropriate in this case?
  1. Modifier -99
  2. Modifier -90
  3. Modifier -52
  4. No modifier would be necessary
Explanation
Answer: B - Modifier -90 (Outside Laboratory)is the appropriate modifier in this case. Modifier -90 is used when the physician’s office bills for the laboratory service, even though they sent the lab sample to an outside laboratory. When the insurance company pays the physician for the lab sample, the physician’s office reimburses the lab for the cost of the service.
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