I am getting a lot of denials this time of year for services provided to children for diagnosis B97.4, RSV as the cause of diseases classified elsewhere. I did some research on this code and found in Encoder Pro that "This code is reported only when the disease caused by RSV is in an organ or site beyond the respiratory tract.". So I have been having to send these back to the providers to determine if this is appropriate code or if it should be another RSV code. There are three other RSV codes, J12.1 (RSV pneumonia), J20.5 (Acute bronchitis due to respiratory syncytial virus) and J21.0 (Acute bronchiolitis due to respiratory syncytial virus). So my question is, for what ‘diseases’ would the B97.4 be appropriate? Just trying to find some type of examples of when a provider would use B97.4 and in what circumstances.

Thanks in advance!

Samantha