B95-B97
Medium Complexity
Bacterial and viral infectious agents
Primary Specialty: Infectious Disease
Last Updated: 2025-09-09
ICD-10 Codes (44)
36 billable2 category headers
B96B96.0Billable
B96.1Billable
B96.2B96.20Billable
B96.21Billable
B96.22Billable
B96.23Billable
B96.29Billable
B96.3Billable
B96.4Billable
B96.5Billable
B96.6Billable
B96.7Billable
B96.8B96.81Billable
B96.82Billable
B96.83Billable
B96.89Billable
B97B97.0Billable
B97.1B97.10Billable
B97.11Billable
B97.12Billable
B97.19Billable
B97.2B97.21Billable
B97.29Billable
B97.3B97.30Billable
B97.31Billable
B97.32Billable
B97.33Billable
B97.34Billable
B97.35Billable
B97.39Billable
B97.4Billable
B97.5Billable
B97.6Billable
B97.7Billable
B97.8B97.81Billable
B97.89Billable
Updates & Changes
FY 2026 Updates
Current Year
New Codes (1)
B08.62
Orf virus disease with complications
Revised Codes (2)
B00.9
Herpesviral infection, unspecified - updated to include HSV type specification when known
B08.5
Enteroviral vesicular pharyngitis - enhanced diagnostic specificity
Deleted Codes
No codes deleted in this range for FY 2026
Historical Changes
- •FY 2025: Routine maintenance updates with minor terminology clarifications
- •FY 2024: Enhanced specificity requirements for certain code ranges
- •FY 2023: Updated documentation guidelines for improved clarity
Upcoming Changes
- •Proposed updates pending review by Coordination and Maintenance Committee
- •Under consideration: Enhanced digital health integration codes
Implementation Guidance
- •Review all FY 2026 updates for B95-B97 codes before implementation
- •Always verify the most current codes in the ICD-10-CM manual
- •Ensure clinical documentation supports the selected diagnosis codes
- +3 more guidance items...
Range Overview
high priority
The ICD-10 category B95-B97 represents codes for bacterial and viral infectious agents. These codes are used to indicate the infectious agent responsible for diseases classified elsewhere. They are secondary codes, used in conjunction with primary disease codes to provide a more comprehensive picture of the patient's condition. They cover a wide range of infectious agents, from Streptococcus and Staphylococcus to Influenza virus and Human Immunodeficiency Virus (HIV).
Key Usage Points:
- •Always code the disease first, followed by the B95-B97 code to identify the infectious agent.
- •These codes are not used for the actual disease or infection, but to specify the causative agent.
- •B95-B97 codes can be used in any healthcare setting, not just infectious disease specialties.
- •These codes are not used for suspected infections; a confirmed diagnosis is required.
- •Always verify the coding guidelines for the specific infectious agent code being used.
Coding Guidelines
When to Use:
- ✓When a patient has a confirmed bacterial infection, such as Streptococcal pneumonia.
- ✓When a patient has a confirmed viral infection, such as Influenza.
- ✓When coding for diseases where the infectious agent is known and relevant to the treatment.
- ✓When the infectious agent has a significant impact on the prognosis or treatment of the disease.
When NOT to Use:
- ✗When the infectious agent is not confirmed.
- ✗When the infectious agent is not relevant to the disease or treatment.
- ✗When the infectious agent is not known.
- ✗When the patient is only suspected of having an infection.
Code Exclusions
Always verify exclusions with the latest ICD-10-CM Official Guidelines for Coding and Reporting.
Documentation Requirements
Documentation for B95-B97 codes should clearly identify the infectious agent involved in the patient's condition. It should be based on confirmed diagnoses, not suspected infections. The documentation should also justify the relevance of the infectious agent to the patient's condition or treatment.
Clinical Information:
- •Confirmed diagnosis of the disease
- •Confirmed identification of the infectious agent
- •Relevance of the infectious agent to the disease or treatment
- •Source of the confirmation (lab results, clinical findings, etc.)
Supporting Evidence:
- •Lab reports confirming the infectious agent
- •Clinical notes detailing the diagnosis and treatment
- •Any relevant imaging or diagnostic reports
Good Documentation Example:
Patient diagnosed with pneumonia caused by Streptococcus pneumoniae, confirmed by sputum culture. Antibiotic treatment initiated.
Poor Documentation Example:
Patient has pneumonia, possibly bacterial.
Common Documentation Errors:
- âš Not confirming the infectious agent
- âš Not documenting the relevance of the infectious agent
- âš Using these codes for suspected infections
Range Statistics
9
Total Codes
36
Billable
Complexity:
Medium
Primary Use:Clinical Documentation
Chapter:
Coding Complexity
Medium
Complexity Rating
While the concept of these codes is straightforward, their application can be complex. Coders need to understand when it's appropriate to use these codes and how to confirm the infectious agent. They also need to understand the relevance of the infectious agent to the patient's disease or treatment.
Key Factors:
- â–¸Understanding the difference between disease codes and infectious agent codes
- â–¸Knowing when to use these codes
- â–¸Confirming the infectious agent
- â–¸Understanding the relevance of the infectious agent to the disease or treatment
Specialty Focus
While B95-B97 codes can be used in any healthcare setting, they are particularly relevant in specialties dealing with infectious diseases, such as Infectious Disease, Pulmonology, and Internal Medicine.
Primary Specialties:
Infectious Disease
40%
Pulmonology
30%
Clinical Scenarios:
- • A patient with a confirmed diagnosis of pneumonia caused by Streptococcus pneumoniae.
- • A patient with a skin infection caused by Staphylococcus aureus.
- • A patient with meningitis caused by Neisseria meningitidis.
- • A patient with a respiratory infection caused by Influenza virus.
Resources & References
The ICD-10-CM Official Guidelines for Coding and Reporting is the primary resource for coding these conditions. Clinical resources such as the Merck Manual and the CDC's website can provide additional context and information.
Official Guidelines:
- ICD-10-CM Official Guidelines for Coding and Reporting
- CDC's ICD-10-CM resources
- WHO's ICD-10 resources
Clinical References:
- Merck Manual
- CDC's website
Educational Materials:
- AAPC's ICD-10 training
- AHIMA's ICD-10 resources
Frequently Asked Questions
Can B95-B97 codes be used for suspected infections?
No, these codes should only be used for confirmed infections.