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ICD-10 Guide
ICD-10 CodesR65.11

R65.11

Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction

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

Code Description

ICD-10 R65.11 is a billable code used to indicate a diagnosis of systemic inflammatory response syndrome (sirs) of non-infectious origin with acute organ dysfunction.

Key Diagnostic Point:

Systemic Inflammatory Response Syndrome (SIRS) of non-infectious origin with acute organ dysfunction is characterized by a systemic inflammatory response that can occur due to various non-infectious triggers such as trauma, pancreatitis, burns, or autoimmune disorders. Clinically, SIRS is defined by the presence of at least two of the following criteria: fever (temperature >38°C or <36°C), tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >20 breaths per minute or arterial CO2 <32 mmHg), and leukocytosis (white blood cell count >12,000 cells/mm³) or leukopenia (white blood cell count <4,000 cells/mm³). Acute organ dysfunction may manifest as altered mental status, acute kidney injury, respiratory failure, or cardiovascular instability. The identification of SIRS is critical as it indicates a high risk for progression to severe sepsis or septic shock, necessitating prompt intervention and management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between infectious and non-infectious causes of SIRS
  • Identifying acute organ dysfunction accurately
  • Understanding the clinical context and triggers for SIRS
  • Ensuring comprehensive documentation of symptoms and lab findings

Audit Risk Factors

  • Inadequate documentation of organ dysfunction
  • Failure to specify the non-infectious origin
  • Misclassification of SIRS as septic when infection is not present
  • Lack of supporting lab findings for SIRS criteria

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of vital signs, lab results, and clinical assessments to support the diagnosis of SIRS and organ dysfunction.

Common Clinical Scenarios

Patients presenting with pancreatitis, severe trauma, or autoimmune flare-ups leading to SIRS.

Billing Considerations

Ensure that the documentation clearly differentiates between infectious and non-infectious causes.

Emergency Medicine

Documentation Requirements

Acute care documentation must include rapid assessment of vital signs, lab results, and immediate interventions.

Common Clinical Scenarios

Patients presenting with acute respiratory distress, altered mental status, or shock due to non-infectious causes.

Billing Considerations

Timely documentation is crucial; ensure that all criteria for SIRS are met and documented.

Coding Guidelines

Inclusion Criteria

Use R65.11 When
  • According to ICD
  • 10 guidelines, SIRS must be coded only when there is evidence of acute organ dysfunction
  • Coders should ensure that all criteria for SIRS are documented and that the non
  • infectious origin is clearly stated

Exclusion Criteria

Do NOT use R65.11 When
No specific exclusions found.

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used for patients presenting with SIRS in the emergency department.

Documentation Requirements

Document the severity of symptoms and the need for immediate intervention.

Specialty Considerations

Emergency medicine providers should ensure that all SIRS criteria are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of SIRS, enabling better tracking of non-infectious causes and associated organ dysfunction, which can improve patient care and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of SIRS, enabling better tracking of non-infectious causes and associated organ dysfunction, which can improve patient care and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of SIRS, enabling better tracking of non-infectious causes and associated organ dysfunction, which can improve patient care and outcomes.

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 criteria for diagnosing SIRS?

The key criteria for diagnosing SIRS include the presence of at least two of the following: fever, tachycardia, tachypnea, and abnormal white blood cell count.

How do I differentiate SIRS from sepsis?

SIRS is diagnosed based on clinical criteria without the presence of infection, while sepsis is characterized by SIRS criteria plus a confirmed or suspected infection.