B97.4 — Respiratory syncytial virus as the cause of diseases classified elsewhere
Is B97.4 billable?
Yes — B97.4 is billable for FY2027. B97.4 is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. B97.4 may be submitted for encounters from October 1, 2026 through September 30, 2027.
B97.4 at a glance
| Code | B97.4 |
|---|---|
| Description | Respiratory syncytial virus as the cause of diseases classified elsewhere |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to B97.4?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name B97.4 directly.
CMS will reject this code as the principal diagnosis on an inpatient claim. It describes something other than the condition chiefly responsible for the admission.
Which MS-DRGs does B97.4 group to?
B97.4 sits in MDC 15 and helps define the logic of 1 MS-DRG (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 791Prematurity with Major Problemsmedical
How is B97.4 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to B97.4. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Respiratory › syncytial virus, as cause of disease classified elsewhere
- Virus, viral › respiratory syncytial › as cause of disease classified elsewhere
- Virus, viral › respiratory syncytial › otitis media
- Virus, viral › respiratory syncytial › upper respiratory infection
- Infection, infected, infective › virus, viral NOS › respiratory syncytial › as cause of disease classified elsewhere (opportunistic)
- Infection, infected, infective › virus, viral NOS › respiratory syncytial › otitis media (opportunistic)
- Infection, infected, infective › virus, viral NOS › respiratory syncytial › upper respiratory infection (opportunistic)
- Infection, infected, infective › respiratoryNEC › upperNOS › viral NOS › due to respiratory syncytial virus (opportunistic)
Excludes1 — never code together
The conditions below can never be reported together with B97.4 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Code first
The underlying condition below must be sequenced before B97.4. B97.4 describes a manifestation and cannot be the principal or first-listed diagnosis.
Inclusion terms
Alternative wording in documentation that is classified to B97.4.
- RSV as the cause of diseases classified elsewhere
Use additional code — inherited from Chapter 1
Report an additional code alongside B97.4 to fully describe the condition. B97.4 is sequenced first.
- code to identify resistance to antimicrobial drugs (Z16.-)
Excludes2 — not included here — inherited from Chapter 1
The conditions below are not part of B97.4, but a patient may have both at the same time. When documentation supports it, B97.4 and the excluded code may both be reported.
- carrier or suspected carrier of infectious disease (Z22.-)
- certain localized infections - see body system-related chapters
- infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)
- infectious and parasitic diseases specific to the perinatal period (P35-P39)
- influenza and other acute respiratory infections (J00-J22)
How long has B97.4 existed?
B97.4 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.
Which codes are confused with B97.4?
ICD-10-CM declares these codes mutually exclusive with B97.4 — exactly one of each pair can be correct for a given encounter.
What other codes are in the B97 family? (8)
- B97.0Adenovirus as the cause of diseases classified elsewhere
- B97.1Enterovirus as the cause of diseases classified elsewherenot billable
- B97.2Coronavirus as the cause of diseases classified elsewherenot billable
- B97.3Retrovirus as the cause of diseases classified elsewherenot billable
- B97.5Reovirus as the cause of diseases classified elsewhere
- B97.6Parvovirus as the cause of diseases classified elsewhere
- B97.7Papillomavirus as the cause of diseases classified elsewhere
- B97.8Other viral agents as the cause of diseases classified elsewherenot billable