B97.4 vs J12.1
B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere) compared with J12.1 (Respiratory syncytial virus pneumonia), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. B97.4 carries an Excludes1 note covering J12.1: “respiratory syncytial virus (RSV) pneumonia (J12.1)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| B97.4Respiratory syncytial virus as the cause of diseases classified elsewhere | J12.1Respiratory syncytial virus pneumonia | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | A00-B99 — Certain Infectious and Parasitic Diseases (A00-B99) | J00-J99 — Diseases of the Respiratory System (J00-J99) |
| Definition | Respiratory syncytial virus as the cause of diseases classified elsewhere is a billable ICD-10-CM diagnosis code (B97.4). | Respiratory syncytial virus pneumonia is a billable ICD-10-CM diagnosis code (J12.1). |
| Includes | RSV as the cause of diseases classified elsewhere | bronchopneumonia due to viruses other than influenza viruses RSV pneumonia |
| Use additional code | — | code, if applicable, to identify resistance to antimicrobial drugs (Z16.-) |
| Code first | related disorders, such as: otitis media (H65.-) | associated influenza, if applicable (J09.X1, J10.0-, J11.0-) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources