ICD-10 Coding for Respiratory Syncytial Virus Infection(J12.1, J20.5, J21.0, B97.4)
Complete ICD-10-CM coding and documentation guide for Respiratory Syncytial Virus Infection. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Respiratory Syncytial Virus Infection
J20-J21Primary Range
Acute Bronchitis and Bronchiolitis
Primary range for acute bronchitis and bronchiolitis due to RSV, including J20.5 and J21.0.
Viral agents as the cause of diseases classified elsewhere
Includes B97.4 for RSV as the causative agent of other conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J12.1 | Pneumonia due to respiratory syncytial virus | Use when pneumonia is confirmed to be caused by RSV. |
|
| J20.5 | Acute bronchitis due to respiratory syncytial virus | Use for confirmed RSV causing acute bronchitis. |
|
| J21.0 | Acute bronchiolitis due to respiratory syncytial virus | Use for confirmed RSV causing acute bronchiolitis, especially in infants. |
|
| B97.4 | Respiratory syncytial virus as the cause of diseases classified elsewhere | Use when RSV is the causative agent of a condition classified elsewhere. |
|
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 RSV infection
Essential facts and insights about Respiratory Syncytial Virus Infection
Primary ICD-10-CM Codes for respiratory syncytial virus infection
Decision Criteria
clinical Criteria
- Confirmed RSV infection with pneumonia symptoms
Applicable To
- RSV pneumonia
Excludes
- Pneumonia due to other specified organisms
Clinical Validation Requirements
- Chest X-ray findings
- RSV confirmation via PCR or antigen test
Code-Specific Risks
- Misclassification if RSV is not confirmed
Coding Notes
- Ensure RSV is confirmed via lab tests before using this code.
J20.5 - Acute bronchitis due to respiratory syncytial virus
Use for confirmed RSV causing acute bronchitis.
Applicable To
- RSV acute bronchitis
Excludes
- Chronic bronchitis
Clinical Validation Requirements
- RSV confirmation via PCR or antigen test
- Symptoms of acute bronchitis
Coding Notes
Ensure documentation specifies RSV as the cause.
J21.0 - Acute bronchiolitis due to respiratory syncytial virus
Use for confirmed RSV causing acute bronchiolitis, especially in infants.
Applicable To
- RSV acute bronchiolitis
Excludes
- Chronic bronchiolitis
Clinical Validation Requirements
- RSV confirmation via PCR or antigen test
- Symptoms of acute bronchiolitis
Coding Notes
Ensure RSV is confirmed via lab tests before using this code.
B97.4 - Respiratory syncytial virus as the cause of diseases classified elsewhere
Use when RSV is the causative agent of a condition classified elsewhere.
Applicable To
- RSV as causative agent
Excludes
- RSV pneumonia (J12.1)
Clinical Validation Requirements
- RSV confirmation via PCR or antigen test
- Link to secondary condition
Coding Notes
Ensure a primary condition code is used first.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Hypoxemia
R09.02Differential 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 Respiratory Syncytial Virus Infection to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J12.1.
Impact
Clinical: Inaccurate diagnosis, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Specify RSV in documentation, Include test results
Impact
Reimbursement: May result in denied claims, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate representation of patient condition
Mitigation Strategy
Document RSV-associated condition and use B97.4 as secondary.
Impact
Reimbursement: Potential claim rejections, Compliance: Violation of coding standards, Data Quality: Misleading clinical data
Mitigation Strategy
Require explicit test result documentation for RSV.
Impact
High risk of audit if RSV is coded without lab confirmation.
Mitigation Strategy
Require lab test results before coding RSV.
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 Respiratory Syncytial Virus Infection, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Respiratory Syncytial Virus Infection
Use these documentation templates to ensure complete and accurate documentation for Respiratory Syncytial Virus Infection. These templates include all required elements for proper coding and billing.
Infant with RSV bronchiolitis
Specialty: PediatricsRequired Elements
- Patient age and symptoms
- RSV test results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Respiratory Syncytial Virus Infection? Ask your questions below.