Pediatric Coding Alert

Answer: The answer is likely going to depend on what the provider has documented.

A positive test doesn’t mean that the physician is giving the patient that diagnosis. If there is no official diagnosis, then do not code the Respiratory syncytial virus (RSV). Sometimes, the physician may hold off on a diagnosis if they feel the test is a false positive or otherwise doesn’t agree with the results.

If there is an official RSV diagnosis, in order for you to report B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere) there needs to be documentation that the RSV was the cause of another condition. This is not only evidenced by the wording in the descriptor but also by the Code first note that instructs you to first report related disorders such as otitis media or an upper respiratory infection.

Additionally, there is no ICD-10 code for just a positive RSV test. The provider does need to confirm the RSV diagnosis and document that this is cause of the cough or other condition which the provider has diagnosed. The best bet is to code the signs and symptoms in the absence of a diagnosis, per ICD-10 guideline I.B.4-6.