OBJECTIVES: International Classification of Diseases 10^th revision (ICD-10) group codes are used to classify and code diagnoses and symptoms recorded alongside hospital care. Discrepancies have been observed between clinical and laboratory diagnoses of respiratory tract infections, including respiratory syncytial virus (RSV). This study compared clinical diagnoses with assigned ICD-10 codes in children with RSV infection. METHODS: This retrospective, non-interventional study included children (aged ≤5 years) hospitalised with PCR-confirmed RSV infection at a German University Hospital from 2015–2018. Patients were classified using primary and overall ICD-10 virus-specific diagnostic codes, whereby multiple ICD codes could be used for a single patient. RESULTS: Overall, 312 patients had PCR-confirmed RSV infection; of these, 62.8% of patients had a clinical diagnosis of bronchiolitis and 29.5% of pneumonia. A primary RSV ICD-10 code was recorded in 68.6% of patients (29.8% J12.1 – RSV pneumonia; 26.6% J20.5 – RSV acute bronchitis; 11.9% J21.0 – RSV bronchiolitis; 0.3% B97.4 – RSV as the cause of disease classified elsewhere) and 27.6% had non-RSV specific primary codes recorded. The most frequently used non-specific RSV code was J06.9 – acute upper respiratory infections of multiple and unspecified sites (10.6%). Primary codes were not reported in five patients with PCR-confirmed RSV infection and seven patients were coded as influenza; however, there were 15 patients with RSV and influenza co-detections. When evaluating the overall RSV ICD codes, cases were coded as J12.1 – RSV pneumonia (30.1%), J20.5 – RSV acute bronchitis (28.5%), B97.4 – RSV (18.6%), and J21.0 – RSV bronchiolitis (11.2%), and 8.7% of patients were not assigned virus-specific codes. CONCLUSIONS: Approximately one third of children with PCR-confirmed RSV infection did not have RSV-specific primary codes. However, children may have been hospitalised for clinical reasons other than RSV-mediated lower respiratory tract disease, such as for RSV-mediated upper respiratory tract disease, for which no ICD code exists.