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ICD-10 Guide
ICD-10 CodesJ21.0

J21.0

Acute bronchiolitis due to respiratory syncytial virus

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 J21.0 is a billable code used to indicate a diagnosis of acute bronchiolitis due to respiratory syncytial virus.

Key Diagnostic Point:

Acute bronchiolitis due to respiratory syncytial virus (RSV) is a common viral infection that primarily affects infants and young children, typically under the age of 2. Clinically, it presents with symptoms such as wheezing, coughing, shortness of breath, and difficulty breathing, often following a mild upper respiratory infection. The disease is characterized by inflammation and obstruction of the small airways (bronchioles) in the lungs, leading to respiratory distress. The anatomy involved includes the bronchioles, which are the smallest air passages in the lungs, and the surrounding alveoli where gas exchange occurs. Disease progression can vary; while many children recover within a week, some may develop severe respiratory distress requiring hospitalization. Diagnostic considerations include clinical evaluation of symptoms, history of exposure to RSV, and, in some cases, laboratory tests such as PCR or antigen detection to confirm RSV infection. Early recognition and management are crucial to prevent complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and sometimes laboratory confirmation.
  • Treatment complexity: Management may include supportive care, bronchodilators, and in severe cases, hospitalization.
  • Documentation requirements: Detailed clinical notes and symptom descriptions are essential for accurate coding.
  • Coding specificity: Specific to RSV-related acute bronchiolitis, necessitating differentiation from other respiratory conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of the causative virus or confusion with other respiratory conditions.
  • Documentation gaps: Incomplete clinical notes regarding symptom severity or treatment provided.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis or if the condition is not well-defined.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute bronchiolitis due to RSV is a significant public health concern, particularly in pediatric populations. It is one of the leading causes of hospitalization in infants, impacting healthcare utilization patterns and resource allocation. Understanding the epidemiology of RSV can help in developing preventive strategies, such as vaccination and public health initiatives, to reduce the incidence and severity of this condition. Quality measures related to the management of bronchiolitis can improve patient outcomes and reduce healthcare costs.

ICD-9 vs ICD-10

Acute bronchiolitis due to RSV is a significant public health concern, particularly in pediatric populations. It is one of the leading causes of hospitalization in infants, impacting healthcare utilization patterns and resource allocation. Understanding the epidemiology of RSV can help in developing preventive strategies, such as vaccination and public health initiatives, to reduce the incidence and severity of this condition. Quality measures related to the management of bronchiolitis can improve patient outcomes and reduce healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the necessity for hospitalization or outpatient management. Common denials may arise from insufficient documentation supporting the diagnosis or treatment provided. Best practices include ensuring that all clinical notes are thorough and that the diagnosis is clearly linked to the services billed. It is also important to verify insurance coverage for treatments related to RSV.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J21.0?

J21.0 specifically covers acute bronchiolitis caused by respiratory syncytial virus (RSV). It is characterized by inflammation of the bronchioles, leading to respiratory distress in infants and young children.

When should J21.0 be used instead of related codes?

J21.0 should be used when the acute bronchiolitis is confirmed to be due to RSV. If the cause is identified as another virus, such as rhinovirus or adenovirus, then related codes like J21.1 should be used.

What documentation supports J21.0?

Documentation should include clinical findings such as wheezing, cough, and respiratory distress, along with any laboratory confirmation of RSV. Detailed notes on the patient's history and symptom progression are also necessary.