R65.21: Severe sepsis with septic shock
R65.21 is a billable, specific ICD-10-CM code for severe sepsis with septic shock. It is valid for submission on a claim.
Check R65.21 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- postprocedural septic shock (T81.12-)
Other codes that can never be billed with R65.21
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
R65.21 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
R65.21 is named in 20 Medicare coverage policies: 20 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52868Billing and Coding: Transesophageal Echocardiography (TEE)
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A56505Billing and Coding: Transesophageal Echocardiography (TEE)
Alphabetic index entries that lead here
- Severe sepsis›with septic shock
- Shock›endotoxic
- Shock›gram-negative
- Shock›septic(due to severe sepsis)
- Sepsis›severe›with septic shock
- Infection, infected, infective›with›organ dysfunction›with septic shock
- Sepsis›with›organ dysfunction›with septic shock
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.