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v1.0.0
ICD-10 Guide
ICD-10 CodesR65.1

R65.1

Systemic inflammatory response syndrome (SIRS) of non-infectious origin

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R65.1 is a billable code used to indicate a diagnosis of systemic inflammatory response syndrome (sirs) of non-infectious origin.

Key Diagnostic Point:

Systemic Inflammatory Response Syndrome (SIRS) of non-infectious origin is characterized by a systemic inflammatory response that can occur due to various non-infectious triggers. Symptoms may include fever, tachycardia, tachypnea, and leukocytosis or leukopenia. The syndrome can arise from conditions such as pancreatitis, trauma, burns, or autoimmune diseases. Clinically, SIRS is identified by the presence of at least two of the following criteria: body temperature >38°C or <36°C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute or arterial CO2 tension <32 mmHg, and white blood cell count >12,000 cells/mm³ or <4,000 cells/mm³. Laboratory findings may reveal elevated inflammatory markers such as C-reactive protein (CRP) and procalcitonin. It is crucial to differentiate SIRS from sepsis, which is specifically caused by infection. Accurate diagnosis and coding are essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between infectious and non-infectious causes
  • Variability in clinical presentation
  • Need for comprehensive documentation of symptoms
  • Potential overlap with other inflammatory conditions

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Misclassification of SIRS as sepsis
  • Failure to specify the non-infectious origin
  • Inconsistent coding across different providers

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of clinical findings, lab results, and the underlying non-infectious cause is essential.

Common Clinical Scenarios

Patients presenting with pancreatitis, autoimmune disorders, or severe trauma.

Billing Considerations

Ensure that the documentation clearly distinguishes SIRS from sepsis and includes all relevant clinical criteria.

Emergency Medicine

Documentation Requirements

Acute care documentation must include vital signs, lab results, and a clear assessment of the patient's condition.

Common Clinical Scenarios

Patients with acute trauma, burns, or severe allergic reactions presenting with SIRS symptoms.

Billing Considerations

Rapid assessment and documentation are critical; ensure that the non-infectious cause is identified and documented.

Coding Guidelines

Inclusion Criteria

Use R65.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that SIRS is coded only when the underlying cause is non
  • infectious and all clinical criteria are met

Exclusion Criteria

Do NOT use R65.1 When
No specific exclusions found.

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used for patients presenting with SIRS symptoms in the emergency department.

Documentation Requirements

Document the patient's presenting symptoms, vital signs, and any lab results.

Specialty Considerations

Emergency medicine providers should ensure that the documentation supports the level of service billed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of SIRS, distinguishing between infectious and non-infectious origins, which aids in better clinical management and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of SIRS, distinguishing between infectious and non-infectious origins, which aids in better clinical management and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the key clinical criteria for diagnosing SIRS?

The key clinical criteria for diagnosing SIRS include an abnormal body temperature, elevated heart rate, increased respiratory rate, and abnormal white blood cell count. At least two of these criteria must be met.