Is R65.11 a billable ICD-10-CM code?

Yes. R65.11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does R65.11 sit in the tabular list?

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block General symptoms and signs (R50-R69).

R65.11

R65.11 — Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction

Billable / specific codeICD-10-CM

R65.11 is a billable, specific ICD-10-CM code for systemic inflammatory response syndrome (sirs) of non-infectious origin with acute organ dysfunction. It is valid for submission on a claim.

Use additional code

Add a secondary code to capture the detail described below.

code to identify specific acute organ dysfunction, such as:
acute kidney failure (N17.-)
acute respiratory failure (J96.0-)
critical illness myopathy (G72.81)
critical illness polyneuropathy (G62.81)
disseminated intravascular coagulopathy [DIC] (D65)
encephalopathy (metabolic) (septic) (G93.41)
hepatic failure (K72.0-)

Risk adjustment

R65.11 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock0.500 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

R65.11 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57326Billing and Coding: Electrocardiograms

How R65.11 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to R65.11.

Syndrome›systemic inflammatory response›with acute organ dysfunction
System, systemic›inflammatory response syndrome›with acute organ dysfunction

Related codes at this level

Codes that share R65.1. If R65.11 is not quite right, the correct code is usually one of these.

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

Questions about R65.11

Is R65.11 a billable ICD-10-CM code?: Yes. R65.11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does R65.11 sit in the tabular list?: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block General symptoms and signs (R50-R69).