ICD-10 Coding for Human Metapneumovirus(J12.3, B97.81)
Complete ICD-10-CM coding and documentation guide for Human Metapneumovirus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Human Metapneumovirus
J12-J18Primary Range
Pneumonia due to specific infectious organisms
This range includes codes for pneumonia caused by specific organisms, including human metapneumovirus.
Viral agents as the cause of diseases classified elsewhere
This range includes codes for identifying viral agents responsible for diseases, such as human metapneumovirus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J12.3 | Pneumonia due to human metapneumovirus | Use when pneumonia is confirmed to be caused by human metapneumovirus. |
|
| B97.81 | Human metapneumovirus as the cause of diseases classified elsewhere | Use as an additional code to specify hMPV as the causative agent in non-pneumonia conditions. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for human metapneumovirus pneumonia
Essential facts and insights about Human Metapneumovirus
Primary ICD-10-CM Codes for human metapneumovirus
Decision Criteria
clinical Criteria
- Presence of pneumonia symptoms and positive hMPV test
Applicable To
- Human metapneumovirus pneumonia
Excludes
- Pneumonia due to other specified organisms
Clinical Validation Requirements
- Radiographic evidence of pneumonia
- Positive PCR test for hMPV
Code-Specific Risks
- Incorrectly using this code without confirmatory testing
Coding Notes
- Ensure that documentation specifies 'human metapneumovirus' and includes confirmatory test results.
B97.81 - Human metapneumovirus as the cause of diseases classified elsewhere
Use as an additional code to specify hMPV as the causative agent in non-pneumonia conditions.
Applicable To
- Human metapneumovirus infection
Excludes
- Diseases not caused by human metapneumovirus
Clinical Validation Requirements
- Positive PCR test for hMPV
Coding Notes
Always used in conjunction with a primary condition code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Human metapneumovirus as the cause of diseases classified elsewhere
B97.81Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Human Metapneumovirus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J12.3.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Always specify the virus when known.
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on disease prevalence and treatment outcomes.
Mitigation Strategy
Always pair B97.81 with a primary condition code like J12.3 or J21.1.
Impact
Using B97.81 as a primary code instead of an ancillary code.
Mitigation Strategy
Educate coders on proper sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Human Metapneumovirus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Human Metapneumovirus
Use these documentation templates to ensure complete and accurate documentation for Human Metapneumovirus. These templates include all required elements for proper coding and billing.
Pediatric Bronchiolitis
Specialty: PediatricsRequired Elements
- Patient age and symptoms
- Test results confirming hMPV
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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