J12.1

J12.1: Respiratory syncytial virus pneumonia

Billable / specific codeICD-10-CM

J12.1 is a billable, specific ICD-10-CM code for respiratory syncytial virus pneumonia. It is valid for submission on a claim.

Check J12.1 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

RSV pneumonia

Excludes2 inherited from the categories above J12.1

Not part of this code, but both may be coded when both are present.

Written on J12: Viral pneumonia, not elsewhere classified

aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
aspiration pneumonia due to anesthesia during pregnancy (O29)
aspiration pneumonia due to anesthesia during puerperium (O89.0)
aspiration pneumonia due to solids and liquids (J69.-)
aspiration pneumonia NOS (J69.0)
congenital pneumonia (P23.0)
congenital rubella pneumonitis (P35.0)
interstitial pneumonia NOS (J84.9)
lipid pneumonia (J69.1)
neonatal aspiration pneumonia (P24.-)

Other codes that can never be billed with J12.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

B97.4Respiratory syncytial virus as the cause of diseases classified elsewhere

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

J12.1 is named in 10 Medicare coverage policies: 10 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52466Nebulizers - Policy Article
A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
A56730Billing and Coding: Respiratory Therapy and Oximetry Services

Alphabetic index entries that lead here

Pneumonia›respiratory syncytial virus(RSV)
Pneumonia›in›respiratory syncytial virus(RSV)
Pneumonia›viral, virus›respiratory syncytial(RSV)
Virus, viral›respiratory syncytial›bronchopneumonia
Virus, viral›respiratory syncytial›pneumonia
Infection, infected, infective›virus, viral NOS›respiratory syncytial›bronchopneumonia
Infection, infected, infective›virus, viral NOS›respiratory syncytial›pneumonia