ICD-10-CM 2027 diagnosis code
J12.1Respiratory syncytial virus pneumonia
J12.1 is a valid, billable ICD-10-CM code for respiratory syncytial virus pneumonia. It can be reported on claims for dates of service from October 1, 2026 – September 30, 2027.
Code unchanged since ICD-10-CM took effect on October 1, 2015. Source: official FY2027 ICD-10-CM release from CDC/NCHS and CMS. Page updated September 29, 2026. About our data
About J12.1
J12.1 is the ICD-10-CM diagnosis code for respiratory syncytial virus pneumonia. It belongs to category J12 (viral pneumonia, not elsewhere classified), block J09-J18 (influenza and pneumonia) and chapter 10 (diseases of the respiratory system). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.
Within J12 (viral pneumonia, not elsewhere classified), J12.1 is specifically for respiratory syncytial virus pneumonia. Related codes cover adenoviral pneumonia (J12.0), parainfluenza virus pneumonia (J12.2), human metapneumovirus pneumonia (J12.3), other viral pneumonia (J12.8) and viral pneumonia, unspecified (J12.9).
Code first: associated influenza, if applicable (J09.X1, J10.0-, J11.0-).
As a secondary diagnosis it is an MCC (major complication or comorbidity), which can move an inpatient stay into the highest-paying "with MCC" MS-DRG of its family, unless the principal diagnosis excludes it.
In MS-DRG v44.0, it is part of the grouping logic for DRG 193 (Simple Pneumonia and Pleurisy with MCC, relative weight 1.2825), DRG 194 (Simple Pneumonia and Pleurisy with CC, relative weight 0.7888) and DRG 195 (Simple Pneumonia and Pleurisy without CC/MCC, relative weight 0.6063), in MDC 04 (Diseases and Disorders of the Respiratory System), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.
It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.
Before ICD-10, this condition was coded in ICD-9-CM as 480.1 (pneumonia due to respiratory syncytial virus).
Coding notes
- RSV pneumonia
Notes that apply from higher levels
Instructions written at a parent level also apply to J12.1.
› From J12 Viral pneumonia, not elsewhere classified
- bronchopneumonia due to viruses other than influenza viruses
- aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
- aspiration pneumonia due to anesthesia during pregnancy (O29)
- aspiration pneumonia due to anesthesia during puerperium (O89.0)
- aspiration pneumonia due to solids and liquids (J69.-)
- aspiration pneumonia NOS (J69.0)
- congenital pneumonia (P23.0)
- congenital rubella pneumonitis (P35.0)
- interstitial pneumonia NOS (J84.9)
- lipid pneumonia (J69.1)
- neonatal aspiration pneumonia (P24.-)
- associated abscess, if applicable (J85.1)
Broader instructions also apply from J09-J18 Influenza and pneumonia and Chapter 10: Diseases of the respiratory system.
Alphabetic index entries
7 entriesTerms in the official ICD-10-CM index that lead to J12.1.
- 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
Codes whose notes reference J12.1
- B97.4Excludes1
MS-DRG v44.0 grouping
All DRGs →Inpatient MS-DRGs this diagnosis can group to, as the principal or a secondary diagnosis, depending on the rest of the claim.
MDC 04 · Diseases and Disorders of the Respiratory System
ICD-9-CM equivalent
Converter →- 480.1Pneumonia due to respiratory syncytial virusexact
From the CMS 2018 General Equivalence Mappings (GEMs), the final GEMs release.
Code history
- 2016
- 2017
- 2018
- 2019
- 2020
- 2021
- 2022
- 2023
- 2024
- 2025
- 2026
- 2027
- FY2016 (effective 10/1/2015): Added (first year of ICD-10-CM)
- No changes since FY2016.
Common questions about J12.1
Is J12.1 billable?
- Yes. J12.1 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).
Can J12.1 be used as a principal diagnosis?
- Yes. The Medicare Code Editor doesn't restrict J12.1 as a principal diagnosis.
Is J12.1 a CC or MCC?
- J12.1 is an MCC (major complication or comorbidity) under MS-DRG v44.0, unless excluded by the principal diagnosis.
What DRG does J12.1 group to?
- J12.1 is used in the MS-DRG v44.0 logic for MS-DRG 193 (Simple Pneumonia and Pleurisy with MCC), MS-DRG 194 (Simple Pneumonia and Pleurisy with CC) and MS-DRG 195 (Simple Pneumonia and Pleurisy without CC/MCC). Which one applies depends on whether it is the principal diagnosis and on the rest of the claim.
What is the ICD-9 code for J12.1?
- The CMS General Equivalence Mappings map J12.1 to ICD-9-CM 480.1.