2027 ICD-10-CM Diagnosis Code R65.11Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction
ICD-10-CM Codes›R00–R99›R50-R69›R65
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 2
- Not a Principal Diagnosis
- Not Chronic
R65.11 is a billable ICD-10-CM diagnosis code for systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 864. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 46 closely related codes. The code is not accepted as a principal diagnosis by the Medicare Code Editor. As a symptom code, it should not be used as a principal diagnosis once a related definitive diagnosis has been established. Coders also document this condition as acute organ dysfunction due to systemic inflammatory response syndrome. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other general signs and symptoms.
For Medicare Advantage risk adjustment, R65.11 maps to CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) under the V28 model, adding a risk factor of about 0.500 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for R65.11.
Medicare Risk Adjustment (HCC)Billing
R65.11 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Acute organ dysfunction due to systemic inflammatory response syndrome
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to R65.11: its own notes plus those printed at R65.1 and Chapter 18. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Code First
The underlying condition named in the note is sequenced before this code.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- 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-)
Notes
General instructions on how these codes are used.
- This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
- Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
- The conditions and signs or symptoms included in categories R00-R94 consist of:
- (a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
- (b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
- (c) provisional diagnosis in a patient who failed to return for further investigation or care;
- (d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
- (e) cases in which a more precise diagnosis was not available for any other reason;
- (f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name R65.11, its category, or a range that includes it.
Use Additional Code 1
These codes say to use an additional code from the note, and R65.11 is one of the codes named.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Syndrome See Also: Disease;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Convert R65.11 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About R65.11Overview
Is R65.11 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does R65.11 group to?
On inpatient claims, systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction maps to MS-DRG 864 (fever and Inflammatory Conditions), which carries a relative weight of 0.8553. Higher weights mean higher Medicare reimbursement.
Is R65.11 a CC or MCC?
CMS lists R65.11 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 46 closely related codes in its exclusion list.
Can R65.11 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Can R65.11 be reported with R65.2?
Not as a rule. The Excludes1 note at R65.1, which applies to R65.11, lists "severe sepsis (R65.2)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is R65.11?
R65.11 (systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction) maps to CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock), commonly written as HCC 2, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 2 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does R65.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, R65.11 adds a risk adjustment factor of about 0.500 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.447 to 0.780 depending on the payment segment). HCC 2 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 2 category page.
