J12.1 Respiratory syncytial virus pneumonia

Billable ICD-10-CM code, FY2026. Acts as a Major Complication or Comorbidity (MCC) as a secondary diagnosis.

Applicable to

• RSV pneumonia

Applies from J12 Viral pneumonia, not elsewhere classified

Includes

• bronchopneumonia due to viruses other than influenza viruses

Excludes2 (not included here)

• 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.-)

Code first

• associated influenza, if applicable (J09.X1, J10.0-, J11.0-)

Code also

• associated abscess, if applicable (J85.1)

MS-DRG index

Defines the logic of DRG(s) 193-195 in MDC 04.

Approximate ICD-9-CM (GEMs)

• 480.1 Pneumonia due to respiratory syncytial virus

Code annotations containing back-references to J12.1

Back-references to J12.1

• Type 1 Excludes: B97.4 Respiratory syncytial virus as the cause of diseases classified elsewhere ("respiratory syncytial virus (RSV) pneumonia (J12.1)")

Back-references to J12

• Code Also: D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS] ("pneumonia (J12-J18)")
• Use Additional: J95.89 Other postprocedural complications and disorders of respiratory system, not elsewhere classified ("bacterial or viral pneumonia (J12-J18)")

Diagnosis Index entries for J12.1

• Infection, infected, infective (opportunistic) › virus, viral NOS › respiratory syncytial (RSV) › bronchopneumonia
• Infection, infected, infective (opportunistic) › virus, viral NOS › respiratory syncytial (RSV) › pneumonia
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › in (due to) › respiratory syncytial virus (RSV)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › respiratory syncytial virus (RSV)
• Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved) › viral, virus (broncho) (interstitial) (lobar) › respiratory syncytial (RSV)
• Virus, viral › respiratory syncytial (RSV) › bronchopneumonia
• Virus, viral › respiratory syncytial (RSV) › pneumonia

Nearby codes

• J12 Viral pneumonia, not elsewhere classified
• J12.0 Adenoviral pneumonia
• J12.1 Respiratory syncytial virus pneumonia (this code)
• J12.2 Parainfluenza virus pneumonia
• J12.3 Human metapneumovirus pneumonia
• J12.8 Other viral pneumonia
• J12.81 Pneumonia due to SARS-associated coronavirus
• J12.82 Pneumonia due to coronavirus disease 2019