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R65.10 ICD-10-CM Code: Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction

Compare with another codeCheck this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 2 Excludes1 · 3 code-first instructions
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 2

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Code firstSequence the underlying condition before this code
  • underlying condition, such as:
  • heatstroke (T67.0-)
  • injury and trauma (S00-T88)
Excludes1Never report with this code
  • sepsis- code to infection
  • severe sepsis (R65.2)
IncludesWhat this code covers
  • Systemic inflammatory response syndrome (SIRS) NOS

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 864 — FEVER AND INFLAMMATORY CONDITIONS (MDC 18)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock

Other models: CMS-HCC V22 HCC 2

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R65.10 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on R65.10 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Systemic inflammatory response syndrome (SIRS) NOS

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from R65.1

Code First

Underlying conditions that must be sequenced before this code.

  • underlying condition, such as:
  • heatstroke (T67.0-)
  • injury and trauma (S00-T88)

Source: inherited from R65.1

Coder workflow for R65.10

MedCoder structured workflow — derived from this code’s own official record

Before you code R65.10

  1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

    Guide: Symptom code vs confirmed diagnosis →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with R65.10. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Is an established diagnosis that explains this sign or symptom documented?
    Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
    No → Continue — the sign or symptom code stands when no definitive diagnosis is established.
  2. Does the documentation support a condition named in R65.10’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewR65.2

  3. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then R65.10.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewT67.0

Consider R65.10. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

Official instructions as workflow

  • Excludes1 — check before selecting R65.10(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with R65.10: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareR65.2

    See the official tabular notes · Guidelines I.A.12.a

  • Code First — sequencing check(3 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before R65.10. Do not add an underlying condition the record does not document.

    ReviewT67.0

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The sign or symptom is documented, and the same record establishes a diagnosis that routinely includes it.

Coding question: Is R65.10 reported in addition to the diagnosis?

Path: Review the documented diagnosis and whether the classification treats this finding as integral to it.

Reason: Signs and symptoms integral to a confirmed diagnosis are not coded separately; those not routinely associated with it may be reported when present (Guidelines I.B.5, I.B.6, I.C.18.b).

Documentation: Both the condition R65.10 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewR65.2

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewT67.0

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse R65.10 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of R65.10 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • R65.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of severe sepsis moves the case to R65.2; the two are not reported together unless documented as unrelated.

    Full comparison: R65.10 vs R65.2 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction is a billable ICD-10-CM diagnosis code (R65.10).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

g. SIRS due to Non-Infectious Process The systemic inflammatory response syndrome (SIRS) can develop as a result of certain non-infectious disease processes, such as trauma, malignant neoplasm, or pancreatitis. When SIRS is documented with a noninfectious condition, and no subsequent infection is documented, the code for the underlying condition, such as an injury, should be assigned, followed by code R65.10, Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction, or code R65.11, Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction. If an associated acute organ dysfunction is documented, the appropriate code(s) for the specific type of organ dysfunction(s) should be assigned in addition to code R65.11. If acute organ dysfunction is documented, but it cannot be determined if the acute organ dysfunction is associated with SIRS or due to another condition (e.g., directly due to the trauma), the provider should be queried.

Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9 a. Human Immunodeficiency Virus (HIV) Infections 1) Code only confirmed cases

6) Sepsis and severe sepsis associated with a noninfectious process (condition) In some cases, a noninfectious process (condition) such as trauma, may lead to an infection which can result in sepsis or severe sepsis. If sepsis or severe sepsis is documented as associated with a noninfectious condition, such as a burn or serious injury, and this condition meets the definition for principal diagnosis, the code for the noninfectious condition should be sequenced first, followed by the code for the resulting infection. If severe sepsis is present, a code from subcategory R65.2 should also be assigned with any associated organ dysfunction(s) codes. It is not necessary to assign a code from subcategory R65.1, Systemic inflammatory response syndrome (SIRS) of non-infectious origin, for these cases.

Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9 a. Human Immunodeficiency Virus (HIV) Infections 1) Code only confirmed cases

Only one code from category R65, Symptoms and signs specifically associated with systemic inflammation and infection, should be assigned. Therefore, when a non-infectious condition leads to an infection resulting in severe sepsis, assign the appropriate code from subcategory R65.2, Severe sepsis. Do not additionally assign a code from subcategory R65.1, Systemic inflammatory response syndrome (SIRS) of non- infectious origin.

Verify Before Coding

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.
  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name R65.10 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Use Additional Code instruction: T67.0 — Heatstroke and sunstroke (via R65.1.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 46 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 1 MS-DRG: DRG 864 (MDC 18).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM016 — Other general signs and symptoms (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

A41.9 — Sepsis, unspecified organism, A42.7 — Actinomycotic sepsis, A48.2 — Nonpneumonic Legionnaires' disease [Pontiac fever], A48.3 — Toxic shock syndrome, A48.4 — Brazilian purpuric fever, A48.8 — Other specified bacterial diseases, A49.01 — Methicillin susceptible Staphylococcus aureus infection, unspecified site, A49.02 — Methicillin resistant Staphylococcus aureus infection, unspecified site, A49.1 — Streptococcal infection, unspecified site, A49.2 — Hemophilus influenzae infection, unspecified site, A49.3 — Mycoplasma infection, unspecified site, A49.8 — Other bacterial infections of unspecified site, A49.9 — Bacterial infection, unspecified, A54.86 — Gonococcal sepsis, B00.7 — Disseminated herpesviral disease, B37.7 — Candidal sepsis, B92 — Sequelae of leprosy, B94.2 — Sequelae of viral hepatitis, B94.8 — Sequelae of other specified infectious and parasitic diseases, B94.9 — Sequelae of unspecified infectious and parasitic disease, +26 more

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) for risk-adjusted payment.

B00.7 — Disseminated herpesviral disease, B37.7 — Candidal sepsis, M35.81 — Multisystem inflammatory syndrome, P02.70 — Newborn affected by fetal inflammatory response syndrome, P36.0 — Sepsis of newborn due to streptococcus, group B, P36.10 — Sepsis of newborn due to unspecified streptococci, P36.19 — Sepsis of newborn due to other streptococci, P36.2 — Sepsis of newborn due to Staphylococcus aureus, P36.30 — Sepsis of newborn due to unspecified staphylococci, P36.39 — Sepsis of newborn due to other staphylococci, P36.4 — Sepsis of newborn due to Escherichia coli, P36.5 — Sepsis of newborn due to anaerobes, P36.8 — Other bacterial sepsis of newborn, P36.9 — Bacterial sepsis of newborn, unspecified, R57.1 — Hypovolemic shock, R57.8 — Other shock, R65.11 — Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction, R65.20 — Severe sepsis without septic shock, R65.21 — Severe sepsis with septic shock, T79.4XXA — Traumatic shock, initial encounter, +31 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other general signs and symptoms).

R63.3 — Feeding difficulties, R63.30 — Feeding difficulties, unspecified, R63.31 — Pediatric feeding disorder, acute, R63.32 — Pediatric feeding disorder, chronic, R63.39 — Other feeding difficulties, R63.4 — Abnormal weight loss, R63.5 — Abnormal weight gain, R63.6 — Underweight, R63.8 — Other symptoms and signs concerning food and fluid intake, R64 — Cachexia, R65.11 — Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction, R68.0 — Hypothermia, not associated with low environmental temperature, R68.11 — Excessive crying of infant (baby), R68.12 — Fussy infant (baby), R68.13 — Apparent life threatening event in infant (ALTE), R68.19 — Other nonspecific symptoms peculiar to infancy, R68.2 — Dry mouth, unspecified, R68.3 — Clubbing of fingers, R68.81 — Early satiety, R68.82 — Decreased libido, +38 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “System, systemic”; these codes share that main term but sit in a different category of the Tabular List.

D68.62 — Lupus anticoagulant syndrome (lupus erythematosus, inhibitor present), M32.9 — Systemic lupus erythematosus, unspecified (lupus erythematosus)

Contextual Map

Every relationship of R65.10 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run R65.10 with this related code in Claim Check

Hierarchy

Referenced by Use Additional Code instructions

  • T67.0 — Heatstroke and sunstroke[Use Additional Code](via R65.1.-): “systemic inflammatory response syndrome (R65.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 2 — Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 864 — FEVER AND INFLAMMATORY CONDITIONS[MS-DRG]: “FEVER AND INFLAMMATORY CONDITIONS (MDC 18)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

MDC crossing

  • MDC 18 — Infectious and Parasitic Diseases, Systemic or Unspecified Sites[MDC crossing]: “Infectious and Parasitic Diseases, Systemic or Unspecified Sites — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Syndrome, systemic inflammatory response (SIRS), of non-infectious origin (without organ dysfunction)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • System, systemic, inflammatory response syndrome (SIRS) of non-infectious origin (without organ dysfunction)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "R65.10 — Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/r65.10-systemic-inflammatory-response-syndrome-sirs-of-non-infectious-origin-without-acute-organ-dysfunction

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R65.10 in its code family, with their registry titles.

View all codes in the R65 family