Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction
ICD-10 R65.10 is a billable code used to indicate a diagnosis of systemic inflammatory response syndrome (sirs) of non-infectious origin without acute organ dysfunction.
Systemic Inflammatory Response Syndrome (SIRS) is a clinical syndrome characterized by a systemic inflammatory response to a variety of clinical insults, which may be infectious or non-infectious in origin. In the case of R65.10, the SIRS is of non-infectious origin and does not involve acute organ dysfunction. Symptoms typically include fever (temperature > 38°C or < 36°C), tachycardia (heart rate > 90 beats per minute), tachypnea (respiratory rate > 20 breaths per minute or arterial CO2 tension < 32 mmHg), and leukocytosis (white blood cell count > 12,000 cells/mm³) or leukopenia (white blood cell count < 4,000 cells/mm³). Common non-infectious causes include trauma, pancreatitis, burns, and autoimmune disorders. The absence of acute organ dysfunction is a critical aspect of this diagnosis, as it differentiates SIRS from sepsis, which involves organ failure. Accurate identification and documentation of the underlying cause are essential for appropriate coding and management.
Comprehensive documentation of clinical findings, including vital signs and laboratory results, is essential. The underlying cause of SIRS must be clearly stated.
Patients presenting with unexplained fever, tachycardia, and elevated white blood cell counts due to conditions like pancreatitis or autoimmune disorders.
Ensure that the absence of acute organ dysfunction is explicitly documented to support the use of R65.10.
Detailed acute care documentation is necessary, including initial assessment findings and any interventions performed.
Patients arriving with signs of SIRS following trauma or burns, requiring immediate evaluation and management.
In emergency settings, rapid assessment and documentation of vital signs and lab results are critical for accurate coding.
Used for patients presenting with SIRS symptoms in the emergency department.
Documentation must support the high severity of the visit, including vital signs and clinical findings.
Emergency medicine providers should ensure thorough documentation of SIRS criteria.
Key symptoms include fever, tachycardia, tachypnea, and abnormal white blood cell counts. Documentation must confirm the absence of acute organ dysfunction.
