2026 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 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

J12.1 is a billable ICD-10-CM diagnosis code for respiratory syncytial virus pneumonia. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 193 through 195. 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

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • RSV pneumonia

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

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)
          • 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

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.

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 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About J12.1Overview

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, 2025 through September 30, 2026.

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 193, 194, 195, with relative weights from 0.6285 to 1.3144 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of J12.1?

Under the General Equivalence Mappings, respiratory syncytial virus pneumonia converts to ICD-9-CM 480.1 (resp syncyt viral pneum). The mapping is a direct match.

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.