ICD-10 Diagnosis Code R65.21

According to ICD-10-CM guidelines this code should not to be used as a principal diagnosis code when a related definitive diagnosis has been established.

Code Edits
The following edits are applicable to this code:
Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Diagnostic Related Groups
The diagnosis code R65.21 is grouped in the following Diagnostic Related Group(s) (MS-DRG V35.0)

• 870 - SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
• 871 - SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
• 872 - SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Convert to ICD-9

• 785.52 - Septic shock (Combination Flag)
• 995.92 - Severe sepsis (Combination Flag)

Synonyms

• Endotoxemia
• Endotoxic shock
• Endotoxicosis
• Failed attempted termination of pregnancy complicated by shock
• Failed attempted termination of pregnancy with septic shock
• Gram-positive septic shock
• Hyperdynamic septic shock
• Hypodynamic septic shock
• Illegal termination of pregnancy complicated by shock
• Illegal termination of pregnancy with septic shock
• Induced termination of pregnancy complicated by septic shock
• Induced termination of pregnancy complicated by shock
• Induced termination of pregnancy complicated by shock
• Legal termination of pregnancy complicated by shock
• Legal termination of pregnancy with septic shock
• Miscarriage complicated by shock
• Miscarriage with septic shock
• Postprocedural septic shock
• Pyrogenic shock
• Septic shock
• Septic shock co-occurrent with acute organ dysfunction due to anaerobic bacteria
• Septic shock co-occurrent with acute organ dysfunction due to Chromobacterium
• Septic shock co-occurrent with acute organ dysfunction due to coagulase-negative Staphylococcus
• Septic shock co-occurrent with acute organ dysfunction due to Enterococcus
• Septic shock co-occurrent with acute organ dysfunction due to Gonococcus
• Septic shock co-occurrent with acute organ dysfunction due to Gram-positive coccus
• Septic shock co-occurrent with acute organ dysfunction due to Group A streptococcus
• Septic shock co-occurrent with acute organ dysfunction due to Group B streptococcus
• Septic shock co-occurrent with acute organ dysfunction due to Haemophilus influenzae
• Septic shock co-occurrent with acute organ dysfunction due to Meningococcus
• Septic shock co-occurrent with acute organ dysfunction due to methicillin resistant Staphylococcus aureus
• Septic shock co-occurrent with acute organ dysfunction due to methicillin susceptible Staphylococcus aureus
• Septic shock co-occurrent with acute organ dysfunction due to Pneumococcus
• Septic shock co-occurrent with acute organ dysfunction due to Pseudomonas
• Septic shock co-occurrent with acute organ dysfunction due to Serratia
• Septic shock co-occurrent with acute organ dysfunction due to Staphylococcus
• Septic shock co-occurrent with acute organ dysfunction due to Streptococcus
• Septic shock due to transfusion
• Septic shock following molar AND/OR ectopic pregnancy
• Severe sepsis with acute organ dysfunction due to Chromobacterium
• Shock following molar AND/OR ectopic pregnancy

Index to Diseases and Injuries
References found for the code R65.21 in the Index to Diseases and Injuries:

• - Infection, infected, infective (opportunistic) - B99.9
  • - with
    • - organ dysfunction (acute) - R65.20
      • - with septic shock - R65.21

• - Sepsis (generalized) (unspecified organism) - A41.9
  • - with
    • - organ dysfunction (acute) (multiple) - R65.20
      • - with septic shock - R65.21
  • - severe - R65.20
    • - with septic shock - R65.21

• - Severe sepsis - R65.20
  • - with septic shock - R65.21

• - Shock - R57.9
  • - endotoxic - R65.21
  • - gram-negative - R65.21
  • - septic (due to severe sepsis) - R65.21

Sepsis

Sepsis is a serious illness. It happens when your body has an overwhelming immune response to a bacterial infection. The chemicals released into the blood to fight the infection trigger widespread inflammation. This leads to blood clots and leaky blood vessels. They cause poor blood flow, which deprives your body's organs of nutrients and oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops and the heart weakens, leading to septic shock.

Anyone can get sepsis, but the risk is higher in

• People with weakened immune systems
• Infants and children
• The elderly
• People with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease
• People suffering from a severe burn or physical trauma

Common symptoms of sepsis are fever, chills, rapid breathing and heart rate, rash, confusion, and disorientation. Doctors diagnose sepsis using a blood test to see if the number of white blood cells is abnormal. They also do lab tests that check for signs of infection.

People with sepsis are usually treated in hospital intensive care units. Doctors try to treat the infection, sustain the vital organs, and prevent a drop in blood pressure. Many patients receive oxygen and intravenous (IV) fluids. Other types of treatment, such as respirators or kidney dialysis, may be necessary. Sometimes, surgery is needed to clear up an infection.

NIH: National Institute of General Medical Sciences

• Blood culture (Medical Encyclopedia)
• Group B streptococcal septicemia of the newborn (Medical Encyclopedia)
• Neonatal sepsis (Medical Encyclopedia)
• Sepsis (Medical Encyclopedia)
• Septic shock (Medical Encyclopedia)
• Septicemia (Medical Encyclopedia)
• Toxic shock syndrome (Medical Encyclopedia)

[Read More]

Shock

Shock happens when not enough blood and oxygen can get to your organs and tissues. It causes very low blood pressure and may be life threatening. It often happens along with a serious injury.

There are several kinds of shock. Hypovolemic shock happens when you lose a lot of blood or fluids. Causes include internal or external bleeding, dehydration, burns, and severe vomiting and/or diarrhea. Septic shock is caused by infections in the bloodstream. A severe allergic reaction can cause anaphylactic shock. An insect bite or sting might cause it. Cardiogenic shock happens when the heart cannot pump blood effectively. This may happen after a heart attack. Neurogenic shock is caused by damage to the nervous system.

Symptoms of shock include

• Confusion or lack of alertness
• Loss of consciousness
• Sudden and ongoing rapid heartbeat
• Sweating
• Pale skin
• A weak pulse
• Rapid breathing
• Decreased or no urine output
• Cool hands and feet

Shock is a life-threatening medical emergency and it is important to get help right away. Treatment of shock depends on the cause.

NIH: National Heart, Lung, and Blood Institute

• Anaphylaxis (Medical Encyclopedia)
• Cardiogenic shock (Medical Encyclopedia)
• Hypovolemic shock (Medical Encyclopedia)
• Septic shock (Medical Encyclopedia)
• Shock (Medical Encyclopedia)

[Read More]

General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

• Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
• No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
• Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.

Present on Admission
The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement.