B97.4 — Respiratory syncytial virus as the cause of diseases classified elsewhere
B97.4 is a billable, specific ICD-10-CM code for respiratory syncytial virus as the cause of diseases classified elsewhere. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Code first
The underlying condition must be sequenced before this code.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- RSV as the cause of diseases classified elsewhere
Risk adjustment
B97.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
B97.4 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A59105Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
- A60187Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
How B97.4 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to B97.4.
- Respiratory›syncytial virus, as cause of disease classified elsewhere
- Virus, viral›respiratory syncytial›as cause of disease classified elsewhere
- Infection, infected, infective›virus, viral NOS›respiratory syncytial›as cause of disease classified elsewhere
Related codes at this level
Codes that share B97. If B97.4 is not quite right, the correct code is usually one of these.
- B97.0Adenovirus as the cause of diseases classified elsewhere
- B97.1Enterovirus as the cause of diseases classified elsewhere
- B97.2Coronavirus as the cause of diseases classified elsewhere
- B97.3Retrovirus as the cause of diseases classified elsewhere
- B97.5Reovirus as the cause of diseases classified elsewhere
- B97.6Parvovirus as the cause of diseases classified elsewhere
- B97.7Papillomavirus as the cause of diseases classified elsewhere
- B97.8Other viral agents as the cause of diseases classified elsewhere
Questions about B97.4
- Is B97.4 a billable ICD-10-CM code?
- Yes. B97.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does B97.4 sit in the tabular list?
- Certain infectious and parasitic diseases (A00-B99), in the block Bacterial and viral infectious agents (B95-B97).
- What cannot be coded together with B97.4?
- B97.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.