J12.1 — Respiratory syncytial virus pneumonia
J12.1 is a billable, specific ICD-10-CM code for respiratory syncytial virus pneumonia. It is valid for submission on a claim.
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
Also inherited, and the opposite of Excludes1: these conditions are not part of J12.1, but a patient can have both, so you may code both.
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
These codes carry an Excludes1 note pointing at J12.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J12.1 alone.
- B97.4Respiratory syncytial virus as the cause of diseases classified elsewhere
Risk adjustment
J12.1 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
J12.1 is named in 14 Medicare coverage policies — 14 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
- A52466Nebulizers - Policy Article
How J12.1 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 J12.1.
- 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
The condition this code belongs to
Every code for the condition on one page, which one applies when, and the mistake coders make with it.
Code history
J12.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share J12. If J12.1 is not quite right, the correct code is usually one of these.
Questions about J12.1
- Is J12.1 a billable ICD-10-CM code?
- Yes. J12.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J12.1 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Influenza and pneumonia (J09-J18).