2026 ICD-10-CM Diagnosis Code B97.4Respiratory syncytial virus as the cause of diseases classified elsewhere
B97.4 is a billable ICD-10-CM diagnosis code for respiratory syncytial virus as the cause of diseases classified elsewhere. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 865 through 866. The code is not accepted as a principal diagnosis by the Medicare Code Editor. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Viral infection.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for B97.4.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Acute lower respiratory infection caused by respiratory syncytial virus
- Acute nasopharyngitis caused by respiratory syncytial virus
- Acute upper respiratory infection caused by respiratory syncytial virus
- Acute viral pharyngitis
- Death associated with respiratory syncytial virus infection
- Healthcare associated respiratory syncytial virus disease
- Paramyxoviridae encephalitis
- Respiratory syncytial virus encephalitis
- Respiratory syncytial virus infection
- Respiratory syncytial virus pharyngitis
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- RSV as the cause of diseases classified elsewhere
Code First
Type 1 Excludes
- acute bronchiolitis due to respiratory syncytial virus RSV J21.0
- acute bronchitis due to respiratory syncytial virus RSV J20.5
- respiratory syncytial virus RSV pneumonia J12.1
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
- Respiratory - See Also: condition;
- syncytial virus, as cause of disease classified elsewhere - See Also: Virus, respiratory syncytial (RSV); - B97.4
External Cause of Injuries IndexGuidance
References for this code in the External Cause of Injuries Index.
- Infection, infected, infective(opportunistic)
- virus, viral NOS
- respiratory syncytial (RSV)
- as cause of disease classified elsewhere
- Respiratory
- syncytial virus, as cause of disease classified elsewhere
- Virus, viral
- respiratory syncytial (RSV)
- as cause of disease classified elsewhere
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Respiratory Syncytial Virus Infections
Respiratory syncytial virus, or RSV, is a common respiratory virus. It usually causes mild, cold-like symptoms. But it can cause serious lung infections, especially in infants, older adults, and people with serious medical problems.
The full article covers:
- What is respiratory syncytial virus (RSV)?
- How is respiratory syncytial virus (RSV) spread?
- Who is at risk for respiratory syncytial virus (RSV) infections?
- What are the symptoms of respiratory syncytial virus (RSV) infections?
- How are respiratory syncytial virus (RSV) infections diagnosed?
- What are the treatments for respiratory syncytial virus (RSV) infections?
- Can respiratory syncytial virus (RSV) infections be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert B97.4 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About B97.4Overview
Is B97.4 (Viral agents as the cause of diseases classified elsewhere) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report respiratory syncytial virus as the cause of diseases classified elsewhere on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does B97.4 group to?
On inpatient claims, respiratory syncytial virus as the cause of diseases classified elsewhere maps to MS-DRG 865, 866, with relative weights from 0.8696 to 1.4983 depending on complications. Higher weights mean higher Medicare reimbursement.
Can B97.4 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because respiratory syncytial virus as the cause of diseases classified elsewhere describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
What is the ICD-9 equivalent of B97.4?
Under the General Equivalence Mappings, respiratory syncytial virus as the cause of diseases classified elsewhere converts to ICD-9-CM 079.6 (resprtry syncytial virus). The mapping is approximate, so confirm the match fits the documentation.
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.
