Skip to main content

B97.4 ICD-10-CM Code: Respiratory syncytial virus as the cause of diseases classified elsewhere

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 3 Excludes1 · 3 code-first instructions

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 865 — VIRAL ILLNESS WITH MCC (MDC 18)
  • MS-DRG 866 — VIRAL ILLNESS WITHOUT MCC (MDC 18)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for B97.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Inclusion Terms

Alternative terms the tabular list files under this code.

  • RSV as the cause of diseases classified elsewhere

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Code First

Underlying conditions that must be sequenced before this code.

  • related disorders, such as:
  • otitis media (H65.-)
  • upper respiratory infection (J06.9)

Coder workflow for B97.4

MedCoder structured workflow — derived from this code’s own official record

Before you code B97.4

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with B97.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in B97.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewJ21.0, J20.5, J12.1

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then B97.4.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewH65, J06.9

Consider B97.4. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

Official instructions as workflow

  • Excludes1 — check before selecting B97.4(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with B97.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ21.0, J20.5, J12.1

    See the official tabular notes · Guidelines I.A.12.a

  • Code First — sequencing check(3 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before B97.4. Do not add an underlying condition the record does not document.

    ReviewH65, J06.9

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition B97.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewJ21.0, J20.5, J12.1

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewH65, J06.9

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse B97.4 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of B97.4 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • J21.0— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of acute bronchiolitis due to respiratory syncytial virus (RSV) moves the case to J21.0; the two are not reported together unless documented as unrelated.

    Full comparison: B97.4 vs J21.0 →

  • J20.5— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of acute bronchitis due to respiratory syncytial virus (RSV) moves the case to J20.5; the two are not reported together unless documented as unrelated.

    Full comparison: B97.4 vs J20.5 →

  • J12.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of respiratory syncytial virus (RSV) pneumonia moves the case to J12.1; the two are not reported together unless documented as unrelated.

    Full comparison: B97.4 vs J12.1 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Respiratory syncytial virus as the cause of diseases classified elsewhere is a billable ICD-10-CM diagnosis code (B97.4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9 a. Human Immunodeficiency Virus (HIV) Infections 1) Code only confirmed cases

b. Infectious agents as the cause of diseases classified to other chapters Certain infections are classified in chapters other than Chapter 1 and no organism is identified as part of the infection code. In these instances, it is necessary to use an additional code from Chapter 1 to identify the organism. A code from category B95, Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified to other chapters, B96, Other bacterial agents as the cause of diseases classified to other chapters, or B97, Viral agents as the cause of diseases classified to other chapters, is to be used as an additional code to identify the organism. An instructional note will be found at the infection code advising that an additional organism code is required.

Verify Before Coding

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name B97.4 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: B34 — Viral infection of unspecified site (via B97.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 59 Use Additional Code instructions across 10 chapters: E06.0 — Acute thyroiditis (via B97.-), G06 — Intracranial and intraspinal abscess and granuloma (via B97.-), H65 — Nonsuppurative otitis media (via B97.-), I30.1 — Infective pericarditis (via B97.-), I33.0 — Acute and subacute infective endocarditis (via B97.-), I40.0 — Infective myocarditis (via B97.-), J01 — Acute sinusitis (via B97.-), J02.8 — Acute pharyngitis due to other specified organisms (via B97.-), J03.8 — Acute tonsillitis due to other specified organisms (via B97.-), J04 — Acute laryngitis and tracheitis (via B97.-), J05 — Acute obstructive laryngitis [croup] and epiglottitis (via B97.-), J06.9 — Acute upper respiratory infection, unspecified, J06.9 — Acute upper respiratory infection, unspecified (via B97.-), J32 — Chronic sinusitis (via B97.-), J36 — Peritonsillar abscess (via B97.-), J37 — Chronic laryngitis and laryngotracheitis (via B97.-), J85 — Abscess of lung and mediastinum (via B97.-), J86 — Pyothorax (via B97.-), J95.851 — Ventilator associated pneumonia (via B97.-), K65 — Peritonitis (via B97.-), +39 more.

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 4 MS-DRGs: DRG 791 (MDC 15), DRG 793 (MDC 15), DRG 865 (MDC 18), DRG 866 (MDC 18).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INF008 — Viral infection.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Viral infection).

+309 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Virus, viral”, “Respiratory”; these codes share that main term but sit in a different category of the Tabular List.

A92.30 — West Nile virus infection, unspecified (West Nile), A92.31 — West Nile virus infection with encephalitis (West Nile, with, encephalitis), A92.32 — West Nile virus infection with other neurologic manifestation (West Nile, with, optic neuritis), A92.39 — West Nile virus infection with other complications (West Nile, with, complications NEC), B25.9 — Cytomegaloviral disease, unspecified (cytomegalovirus), B34.8 — Other viral infections of unspecified site (specified NEC), J06.9 — Acute upper respiratory infection, unspecified (respiratory syncytial, upper respiratory infection), J09.X2 — Influenza due to identified novel influenza A virus with other respiratory manifestations (swine influenza), J12.1 — Respiratory syncytial virus pneumonia (respiratory syncytial, pneumonia), J20.5 — Acute bronchitis due to respiratory syncytial virus (respiratory syncytial, bronchitis), J21.0 — Acute bronchiolitis due to respiratory syncytial virus (respiratory syncytial, bronchiolitis), P22.0 — Respiratory distress syndrome of newborn (distress syndrome), P22.1 — Transient tachypnea of newborn (distress syndrome, type II)

Contextual Map

Every relationship of B97.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run B97.4 with these 13 related codes in Claim Check

Hierarchy

Excludes1

Code First

Referenced by Excludes1 notes

Referenced by Use Additional Code instructions (59)

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2027
  • MDC 18 — Infectious and Parasitic Diseases, Systemic or Unspecified Sites[MDC crossing]: “Infectious and Parasitic Diseases, Systemic or Unspecified Sites — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Infection, infected, infective (opportunistic), virus, viral NOS, respiratory syncytial (RSV), as cause of disease classified elsewhere[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Respiratory, syncytial virus, as cause of disease classified elsewhere[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Virus, viral, respiratory syncytial (RSV), as cause of disease classified elsewhere[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (24)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "B97.4 — Respiratory syncytial virus as the cause of diseases classified elsewhere." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/b97.4-respiratory-syncytial-virus-as-the-cause-of-diseases-classified-elsewhere

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Respiratory syncytial virus as the cause of diseases classified elsewhere

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to B97.4 in its code family, with their registry titles.

View all codes in the B97 family