Clinical Context
A 27-year-old sexually active patient presents to a sexual health clinic with symptoms of urethral discharge and dysuria after unprotected intercourse. A clinician collects an oral, rectal, and vaginal swab based on reported exposure sites and clinical exam. Rapid molecular testing for Neisseria gonorrhoeae is positive, and the clinician orders a targeted proprietary assay to determine ciprofloxacin susceptibility by detecting a specific resistance-associated mutation in N. gonorrhoeae. The specimen is sent to MedArbor Diagnostics / SpeeDx Inc. for the proprietary test reported by 0483U. Results guide epidemiologic surveillance and, where permitted by local treatment guidance, targeted antibiotic selection when ciprofloxacin susceptibility is confirmed.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | Default billing indicator (no modifier) | Use when no other modifier applies and the service is furnished as usual. |
22 | Increased procedural services | Use when work required is substantially greater than typically required for this test (document justification).
52 | Reduced services | Use when the test is partially reduced or not fully performed (document reason).
53 | Discontinued procedure | Use when testing was started but discontinued due to circumstances that threatened patient safety or specimen integrity.
59 | Distinct procedural service | Use when this laboratory test is distinct and independent from other services performed on the same day (use sparingly for labs).
90 | Reference (outside) laboratory | Use when the specimen is sent to an outside laboratory for this proprietary test.
91 | Repeat clinical diagnostic laboratory test | Use when the same test is repeated on the same day to confirm results.
91 is often used for repeat molecular tests to confirm unexpected or indeterminate findings.
26 | Professional component | Use if billing only for the professional interpretation of the test by a qualified provider.
TC | Technical component | Use if billing only for the technical component (laboratory processing) of the test.
| Taxonomy Code | Specialty | Notes |
|---|
207RG0100X | Infectious Disease | Specialists may order targeted susceptibility testing for complex cases or treatment failures. |
207L00000X | Pathology & Laboratory Medicine | Laboratory directors and clinical pathologists oversee testing and result validation.
207V00000X | Public Health & General Preventive Medicine | Public health clinicians use results for surveillance and outbreak management.
208000000X | Obstetrics & Gynecology | OB/GYN clinicians commonly collect vaginal specimens and manage treatment of gonorrhea in patients assigned female at birth.
2080P0208X | Family Medicine | Primary care and sexual health clinicians frequently collect specimens and order NAAT and susceptibility testing.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
A54.01 | Gonococcal infection of lower genitourinary tract, female | Primary diagnosis for symptomatic female patients undergoing gonorrhea testing and susceptibility assessment. |
A54.02 | Gonococcal infection of lower genitourinary tract, male | Primary diagnosis for symptomatic male patients where susceptibility testing may be ordered.
A54.03 | Gonococcal infection of pharynx | Relevant when an oral swab is tested for ciprofloxacin resistance-associated mutation.
A54.04 | Gonococcal infection of rectum | Relevant when a rectal swab is tested for ciprofloxacin resistance-associated mutation in patients with receptive anal exposure.
A64 | Unspecified sexually transmitted infection (not HIV) | Used when STI is suspected but specific organism not yet confirmed; triggers diagnostic testing including 0483U once gonorrhea is identified.
Z11.3 | Encounter for screening for infections with a predominantly sexual mode of transmission | Relevant for asymptomatic screening where positive NAAT may prompt reflex susceptibility testing using 0483U.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
87471 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | Commonly used initial NAAT to detect N. gonorrhoeae before ordering targeted susceptibility testing with 0483U. |
87270 | Culture, bacterial, any other source except urine, pathogenic organisms identification | Used when culture is performed to obtain isolates for phenotypic susceptibility testing or confirmatory testing.
87651 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis | Often performed concurrently with gonorrhea NAAT as part of STI screening and specimen collection.
99000 | Handling and/or conveyance of specimen for transfer to another laboratory | May be used when specimens are transported to an outside reference lab such as MedArbor Diagnostics / SpeeDx Inc. for 0483U testing.
G0471 | Specimen collection for human papillomavirus testing, cervical or vaginal | When combined pelvic/sexually transmitted infection specimen collection is performed, related specimen collection codes may apply.