ICD Code J12.1

ICD code J12.1 is respiratory syncytial virus (RSV) pneumonia, which refers to a lung infection caused by the RSV virus.

1. Patient presents with clinical signs and symptoms of lower respiratory tract infection, such as cough, wheezing, dyspnea, or increased respiratory effort.

2. Laboratory confirmation of respiratory syncytial virus (RSV) infection through antigen detection, PCR, or viral culture from respiratory specimens.

3. Radiographic evidence of pneumonia, such as infiltrates or consolidation on chest imaging.

4. Exclusion of other viral or bacterial pathogens as the primary cause of pneumonia.

5. Acute onset of illness, typically during RSV season, with or without fever.

6. Presence of risk factors such as young age, prematurity, or underlying cardiopulmonary disease may support the diagnosis but are not required.

Relevant CPT codes that may be used to treat ICD code J12.1 include:

- 99221–99223 (Initial hospital care)

- 99231–99233 (Subsequent hospital care)

- 99238–99239 (Hospital discharge services)

- 94002–94004 (Ventilation management)

- 94640 (Pressurized or non-pressurized inhalation treatment for acute airway obstruction)

- 94660 (Continuous positive airway pressure ventilation)

- 31500 (Intubation, endotracheal, emergency procedure)

- 36415 (Collection of venous blood by venipuncture)

- 87070 (Culture, bacterial; any other source except urine, blood or stool)

- 87634 (Infectious agent detection by nucleic acid, RSV, direct probe technique)

- 87636 (Infectious agent detection by nucleic acid, influenza virus and RSV, multiplex amplified probe technique)

- 96372 (Therapeutic, prophylactic, or diagnostic injection)

CPT code selection should be based on the specific services rendered and clinical documentation for J12.1.

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