2027 ICD-10-CM Diagnosis Code J12.1Respiratory syncytial virus pneumonia

ICD-10-CM Codes›J00–J99›J09-J18›J12

ICD-10-CM J12.1
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

J12.1 is a billable ICD-10-CM diagnosis code for respiratory syncytial virus pneumonia. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 193 through 195. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 121 closely related codes. Coders also document this condition as bronchopneumonia caused by respiratory syncytial virus. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pneumonia (except that caused by tuberculosis) and Viral infection.

Code Identity

ICD-10-CM Code
J12.1
Billable Status
Yes — Valid for Submission
Code Describes
Respiratory syncytial virus pneumonia
Short Description
Respiratory syncytial virus pneumonia
Same as the full description in the CMS dataset.
Parent Code
J12
Viral pneumonia, not elsewhere classified

Code Classification

ChapterJ00–J99Diseases of the respiratory system
SectionJ09-J18Influenza and pneumonia
CategoryJ12Viral pneumonia, not elsewhere classified
This CodeJ12.1Respiratory syncytial virus pneumonia

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Bronchopneumonia caused by respiratory syncytial virus
  • Bronchopneumonia due to virus
  • Pneumonia caused by respiratory syncytial virus
  • Respiratory syncytial virus bronchitis

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to J12.1: its own notes plus those printed at J12, block J09-J18, and Chapter 10. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From J12 Viral pneumonia, not elsewhere classified applies to 8 codes
  • bronchopneumonia due to viruses other than influenza viruses

Applicable To

Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.

  • RSV pneumonia

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From J12 Viral pneumonia, not elsewhere classified applies to 8 codes
  • 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.-)
From Block J09-J18 Influenza and pneumonia applies to 53 codes
  • allergic or eosinophilic pneumonia (J82)
  • aspiration pneumonia NOS (J69.0)
  • meconium pneumonia (P24.01)
  • neonatal aspiration pneumonia (P24.-)
  • pneumonia due to solids and liquids (J69.-)
  • congenital pneumonia (P23.9)
  • lipid pneumonia (J69.1)
  • rheumatic pneumonia (I00)
  • ventilator associated pneumonia (J95.851)
From Chapter 10 (J00-J99) Diseases of the respiratory system applies to 366 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • smoke inhalation (T59.81-)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Code First

The underlying condition named in the note is sequenced before this code.

From J12 Viral pneumonia, not elsewhere classified applies to 8 codes

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Block J09-J18 Influenza and pneumonia applies to 53 codes
  • code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
From Chapter 10 (J00-J99) Diseases of the respiratory system applies to 366 codes
  • code, where applicable, to identify:
  • exposure to environmental tobacco smoke (Z77.22)
  • exposure to tobacco smoke in the perinatal period (P96.81)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Code Also

A second code may be needed to fully describe the condition; the note gives no sequencing direction.

From J12 Viral pneumonia, not elsewhere classified applies to 8 codes
  • associated abscess, if applicable (J85.1)

Notes

General instructions on how these codes are used.

From Chapter 10 (J00-J99) Diseases of the respiratory system applies to 366 codes
  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name J12.1, its category, or a range that includes it.

Excludes1 1

These codes carry an Excludes1 note naming J12.1: they are not reported together with it, unless the two conditions are unrelated.

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

Use Additional Code 1

These codes say to use an additional code from the note, and J12.1 is one of the codes named.

  • J95.89 Other postprocedural complications and disorders of respiratory system, not elsewhere classified
    bacterial or viral pneumonia (J12-J18) names J12-J18, which includes this code

Code Also 2

These codes say J12.1 may also be needed to fully describe the condition. The note gives no sequencing direction.

  • J69 Pneumonitis due to solids and liquids
    viral pneumonia (J12.-) names J12.-, which includes this code
  • D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]
    pneumonia (J12-J18) names J12-J18, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR RSP002
Pneumonia (except that caused by tuberculosis)
Default principal diagnosis: inpatient Yes · outpatient Yes
CCSR INF008
Viral infection
Default principal diagnosis: inpatient No · outpatient No

Clinical InformationClinical

  • Respiratory Syncytial Virus Pneumonia

    pneumonia that is attributed to the respiratory syncytial virus.

  • Pneumonia, Viral

    inflammation of the lung parenchyma that is caused by a viral infection.

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 J12.1 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
480.1 Resp syncyt viral pneum
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About J12.1Overview

What is the ICD-10 code for respiratory syncytial virus pneumonia?

The ICD-10-CM code for respiratory syncytial virus pneumonia is J12.1 (sometimes written as J121). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is J12.1 (Viral pneumonia, not elsewhere classified) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report respiratory syncytial virus pneumonia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does J12.1 group to?

When respiratory syncytial virus pneumonia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 195, 193, 194, with relative weights from 0.6062 to 1.2824 depending on complications. Higher weights mean higher Medicare reimbursement.

Is J12.1 a CC or MCC?

CMS lists J12.1 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 121 closely related codes in its exclusion list.

What is coded first with J12.1?

The Code First note at J12, which applies to J12.1, reads: associated influenza, if applicable (J09.X1, J10.0-, J11.0-). When one of these applies, it is sequenced before J12.1.