Symptoms and signs specifically associated with systemic inflammation and infection
In General symptoms and signs (R50-R69), chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings
4 billable codes under R65: 3 are an MCC, 1 is a CC; all map to HCC 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.
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Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers when to report symptom, sign, and abnormal finding codes (R00-R99), plus specific rules for falls, coma scales, non-infectious SIRS, death NOS, and NIHSS scores.
- Use of symptom codes (page 75)
- Use of a symptom code with a definitive diagnosis code (page 75)
- Combination codes that include symptoms (page 75)
- Repeated falls (page 76)
- Coma (page 76)
- Functional quadriplegia (page 76)
- SIRS due to Non-Infectious Process (page 77)
- Death NOS (page 77)
All codes under R65
R65 can't be used on a claim. Pick a billable code below; grey headings group them.
- R65.1Systemic inflammatory response syndrome (SIRS) of non-infectious origin
- R65.10Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction
- R65.11Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction
- R65.2Severe sepsis
- R65.20Severe sepsis without septic shock
- R65.21Severe sepsis with septic shock
R65 MS-DRGs
As the principal diagnosis, the billable codes under R65 group to MS-DRG 864, 870, 871, or 872 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 864 Fever and Inflammatory Conditions (2 of 4 codes)
- DRG 870 Septicemia or Severe Sepsis with MV >96 Hours (2 of 4 codes)
- DRG 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC (2 of 4 codes)
- DRG 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC (2 of 4 codes)
Code history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.