ICD Code R65.11

ICD code R65.11 is used to identify a condition known as Systemic Inflammatory Response Syndrome (SIRS) of non-infectious origin that is accompanied by acute organ dysfunction. This code is applied when a patient exhibits a systemic inflammatory response due to factors other than infection, such as trauma or pancreatitis, and this response leads to the failure or dysfunction of one or more organs. Proper documentation and coding of this condition are crucial for accurate billing and effective management of healthcare resources.

1. Presence of Systemic Inflammatory Response Syndrome (SIRS): The patient must exhibit clinical signs of SIRS, which typically include at least two of the following:

- Body temperature higher than 38°C (100.4°F) or lower than 36°C (96.8°F).

- Heart rate exceeding 90 beats per minute.

- Respiratory rate greater than 20 breaths per minute or arterial carbon dioxide tension (PaCO2) less than 32 mm Hg.

- Abnormal white blood cell count, either higher than 12,000/µL or lower than 4,000/µL, or the presence of more than 10% immature (band) forms.

2. Non-Infectious Origin: The SIRS must be attributed to a non-infectious cause. This can include conditions such as:

- Trauma

- Burns

- Pancreatitis

- Autoimmune disorders

- Hemorrhage

3. Acute Organ Dysfunction: There must be evidence of acute organ dysfunction, which can manifest as:

- Cardiovascular dysfunction, such as hypotension or the need for vasopressors.

- Respiratory dysfunction, such as acute respiratory distress syndrome (ARDS) or hypoxemia.

- Renal dysfunction, indicated by elevated creatinine levels or reduced urine output.

- Hepatic dysfunction, shown by elevated liver enzymes or bilirubin levels.

- Hematologic dysfunction, such as coagulopathy or thrombocytopenia.

- Neurologic dysfunction, including altered mental status or encephalopathy.

4. Exclusion of Infectious Causes: It is crucial to rule out infectious causes of SIRS, such as sepsis, through appropriate diagnostic testing and clinical evaluation.

By meeting these criteria, healthcare providers can accurately utilize the ICD code for systemic inflammatory response syndrome of non-infectious origin with acute organ dysfunction, ensuring precise documentation and effective management of the condition.

For the ICD code R65.11, which pertains to systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction, the relevant CPT codes that may be applicable include:

1. 99291 - Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.
2. 99292 - Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes.
3. 99468 - Initial inpatient neonatal critical care, per day, for patients 28 days of age or younger.
4. 99469 - Subsequent inpatient neonatal critical care, per day, for patients 28 days of age or younger.
5. 99471 - Initial inpatient pediatric critical care, per day, for patients 29 days through 24 months of age.
6. 99472 - Subsequent inpatient pediatric critical care, per day, for patients 29 days through 24 months of age.
7. 99475 - Initial inpatient pediatric critical care, per day, for patients 2 through 5 years of age.
8. 99476 - Subsequent inpatient pediatric critical care, per day, for patients 2 through 5 years of age.
9. 99477 - Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services.
10. 99478-99480 - Subsequent intensive care services for the neonate or infant.

These CPT codes are typically used in scenarios where critical care services are required due to the severity of the condition associated with the ICD code R65.11. It's important for healthcare providers to select the appropriate CPT code based on the specific services rendered and the patient's age and condition.

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