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2025 ICD-10-CM code J12

Viral pneumonia, not elsewhere classified.

Do not use J12 for reimbursement purposes; more specific codes exist (e.g., J12.1 for RSV pneumonia, J12.0 for adenoviral pneumonia). Use additional codes for associated conditions, such as influenza or lung abscess.

Medical necessity for treating viral pneumonia is established by the presence of clinical signs and symptoms, such as fever, cough, shortness of breath, and abnormal chest x-ray findings.The severity of the symptoms and the patient's overall health condition determine the level of care required.

Clinicians diagnosing and treating viral pneumonia should consider the specific viral etiology if known and document it accordingly. This includes ordering appropriate diagnostic tests and providing supportive care or antiviral therapy as needed.

IMPORTANT:If applicable, use additional codes for influenza (J09.X1, J10.0-, J11.0-) and lung abscess (J85.1).

In simple words: Your lungs are inflamed due to a viral infection other than the flu. This is a type of pneumonia affecting smaller airways in the lungs.

Bronchopneumonia due to viruses other than influenza viruses.

Example 1: A 3-year-old child presents with cough, fever, and difficulty breathing. Testing confirms a respiratory syncytial virus (RSV) infection, leading to a diagnosis of RSV pneumonia (J12.1)., A 65-year-old patient with a history of COPD develops pneumonia. While influenza is ruled out, other viral tests are inconclusive, resulting in a diagnosis of viral pneumonia, not elsewhere classified (J12)., A patient presents with symptoms suggestive of pneumonia. Initial tests are negative for bacterial infection, and the clinical picture suggests a viral etiology. Pending further investigation, viral pneumonia NOS (J12) is used.

Documentation should include signs and symptoms, chest x-ray findings, and laboratory results, such as viral testing, to confirm the diagnosis of viral pneumonia and rule out other causes.

** Excludes2: 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 the 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.-).

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