2025 ICD-10-CM code J12.89
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Influenza and pneumonia - Viral pneumonia, not elsewhere classified Diseases of the respiratory system (J00-J99) Feed
Other viral pneumonia; this code is used for viral pneumonia not otherwise specified.
Medical necessity for J12.89 is established by the presence of clinical findings consistent with pneumonia (e.g., cough, fever, shortness of breath, chest pain, abnormal chest X-ray findings) and confirmation of viral etiology through laboratory testing.Treatment may include supportive measures and antiviral medications in appropriate cases.
Diagnosis and management of viral pneumonia, including assessment of symptoms, ordering of diagnostic tests (e.g., chest X-ray, blood tests), and implementation of appropriate treatment (e.g., supportive care, antiviral medications).
In simple words: This code is for a lung infection (pneumonia) caused by a virus that isn't specifically identified.Doctors use it when they know it's a viral pneumonia but don't know the exact type of virus.
J12.89, Other viral pneumonia, is an ICD-10-CM code that classifies viral pneumonia not specified elsewhere.It encompasses various viral pneumonias not explicitly detailed in other ICD-10-CM codes.This code should be used when the specific type of virus causing the pneumonia is unknown or not documented.It is crucial to code any associated abscess (J85.1) and influenza if applicable (J09.X1, J10.0-, J11.0-).
Example 1: A 35-year-old patient presents with cough, fever, shortness of breath, and chest pain.Chest X-ray reveals infiltrates consistent with pneumonia.Viral respiratory panel is positive, but the specific virus is not identified.J12.89 is coded., A 68-year-old patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with worsening dyspnea and productive cough.Chest X-ray shows bilateral pneumonia.Viral testing is inconclusive. J12.89 is coded., A 10-year-old child presents with fever, cough, and wheezing.Chest X-ray confirms pneumonia, and respiratory viral panel is positive for RSV, but the reporting physician did not specify the type of pneumonia and used the unspecified viral pneumonia code.
Patient history (including symptoms, exposure to potential pathogens, travel history), physical examination findings, chest X-ray results, laboratory test results (e.g., complete blood count, blood cultures, viral respiratory panel), and treatment plan.
** Always ensure proper documentation to support the diagnosis.Use of this code should be reserved for cases where a more specific viral pneumonia code cannot be applied.The use of this code may influence reimbursement; always verify with the payer.
- Payment Status: Active
- Specialties:Pulmonology, Internal Medicine, Pediatrics, Infectious Disease
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office