Primary Care Coding Alert

Answer: ICD-10 code B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere) would not be the appropriate code.

Here’s why: It’s never wise to report a diagnosis code based on a positive test alone. A positive test doesn’t necessarily mean a diagnosis. For instance, the physician may suspect a false positive. Also, there is a Code first note which requires that you first code the disease the RSV caused. The physician has not determined the patient has RSV; therefore, they also haven’t linked the RSV to another disease classified elsewhere. The physician would need to at least diagnose otitis media, an upper respiratory infection, or something similar and link it to an official RSV diagnosis to justify use of B97.4.

You have the option to query the provider if you suspect the medical record is incomplete.

Note: If you do query the provider and find that the patient does have an infection caused by RSV, B97.4 may still not be the right code. For example, if the physician diagnosed the patient with something specific like bronchitis that was caused by RSV, then you’d select a code such as J20.5 (Acute bronchitis due to respiratory syncytial virus).