Wiki RSV as the cause of diseases classified elsewhere B97.4

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sammartin92472

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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
 
go look in your code book. At the section for codes B95-B97 there is this note:
Note
• These categories are provided for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere

Meaning these are secondary codes and the provider must document some other disease that this infections condition relates to.
 
Honestly?? That is up to the provider to document, now you are in the MD area of expertise not mine. And if you did know, would you know all of the possibilities? probably not.
 
Ok, so I'm not trying to be an MD here, I'm trying to get an idea of when B97.4 might be used, not all the possibilities. I'm anticipating this question from my offices about this and when this code would be used, not trying to be the MD. They are going to question why this code even exists and when it is appropriate to use it. I'm guessing that if an illness doesn't fall into the bronchitis, bronchiolitis or pneumonia categories, then whatever that other process is would be the primary and the B97.4 would be the supplemental code to identify it as the cause. That's all I'm asking.

But thanks for the attack in your response. Feel free to never respond to any of my posts again.
 
I was not attacking you, I am trying to get you to see that there are numerous possibilities and not restricted to just respiratory. But it would be documented and would have to be documented as in the specific disease to be coded as the B97 code. What diseases... the possibilities are endless. It could be a cardiology condition, neurological, joint related and so on. So no attack sorry if you felt that way.
 
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