Severe sepsis

ICD10 Diagnosis
Dx:	Severe sepsis
ICD10 code:	R65.1
Pre-ICD10 counterpart:	Severe Sepsis
Charlson/ALERT Scale:	none
APACHE Como Component:	none
APACHE Acute Component:	2019-0: Sepsis
Start Date:
Stop Date:
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

• SMW
  • 2019-01-01
  • 2999-12-31
  • R65.1

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Additional Info

• Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016). These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS). In the 2016 definitions we have just 2 subcategories:
  • Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis"
  • Septic shock is a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone
• For these the cause is proven infection, OR presumed infection -- thus positive cultures are not required.
• The 2016 consensus group defined the ORGAN DYSFUNCTION as an acute CHANGE from patient's baseline total SOFA score by 2 or more points -- where the baseline SOFA score can be assumed to be 0 in patients not known to have preexisting organ dysfunction.
• Here is the SOFA scoring:

Category	0	1	2	3	4
PaO2/FIO2	>=400	<400	<300	<200	<100
Platelets	>=150	<150	<100	<50	<20
Serum bilirubin (uM)	<20	20-32	33-101	102-204	>204
Cardiovascular	MAP>=70	MAP<70	see note A	see note B	see note C
GCS	15	13-14	10-12	6-9	<6
Serum creatinine (uM)	<110	110-170	171-299	300-440	>440
Urine output (mL/day)				<500	<200

• Note A: dopamine < 5 OR any dose of dobutamine
• Note B: dopamine 5.1-15 OR epi<=0.1 OR norepi<=0.1
• Note C: dopamine >15 OR epi>0.1 OR norepi>0.1
• for these all doses are in microgram/kg/min

Alternate ICD10s to consider coding instead or in addition

• Severe sepsis
• Shock, septic
• Puerperal (post-delivery) infections or sepsis
• Shock, NOS
• Shock, cardiogenic
• Shock, hypovolemic shock or hemorrhagic shock
• Toxic shock syndrome
• Bacteremia, NOS AND Fungemia, NOS -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).

Candidate Combined ICD10 codes

• Also code the causative infection.

Related Articles

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ENT	Testing Imaging	Cardiovascular Aneurysm Aortic Aneurysm Arrhythmia Arterial thromboembolism Atherosclerosis Cardiac septum problem Cerebral Hemorrhage/Stroke Heart valve disease Hemorrhage Hypertension Hypotension Ischemia Ischemic gut Ischemic heart disease Myocardial Infarction Pulmonary embolism Pulmonary hypertension Vasculitis Venous thromboembolism	Hereditary/congenital
Eye	Mechanism Transportation mechanism	Neoplastic Benign neoplasm Endocrine neoplasm Female genital neoplasm Gastrointestinal neoplasm Heme/immunology neoplasm Leukemia Lymphoma Male genital neoplasm Metastasis Musculoskeletal/soft tissue neoplasm Neuro neoplasm Primary malignancy Renal/Urinary neoplasm Respiratory neoplasm Skin neoplasm	Heme/immunology Allergy Anemia Heme/immunology neoplasm Hemophilia Leukemia Thrombocytopenia
Misc Adverse effect Alcohol related Allergy Anesthetic related Antidepressant related Awaiting/delayed transfer COVID Cannabis related Cocaine related Decubitus ulcer Diagnosis implying death Exposure Fistula Hallucinogen related Has one Healthcare contact Hemorrhage Iatrogenic Metabolic/nutrition Non-traumatic fracture Observation Organ removal Ostomy Overdose Paralysis Past medical history Poisoning Psychoactive substance NOS related Radiation related Retired Code Rheumatic disease Sedative related Shock Solvent related Spine Stimulant related Transplant	Reproductive Abortion Breast disease Female genital neoplasm Male genital neoplasm Peripartum	Gastrointestinal Cirrhosis GI ulcer Gastroenteritis Gastrointestinal neoplasm Hepatitis Hernia Inflammatory Bowel Disease Intra-abdominal infection Ischemic gut Liver disease Liver failure Pancreas disease Pancreatitis Peptic ulcer	Musculoskeletal/soft tissue Hernia Joint/ligament trauma Muscle problem Muscles/tendon trauma Musculoskeletal/soft tissue neoplasm Osteomyelitis
Psych Addiction Antidepressant related Delirium Dementia Hallucinogen related Opioid related Psychoactive substance NOS related Sedative related Solvent related Stimulant related Withdrawal	Respiratory Asthma Influenza Inhalation Lower respiratory tract infection Pleural abnormalities Pneumoconiosis Pneumonia Pneumothorax Pulmonary embolism Respiratory neoplasm Sleep disorder Tracheostomy Upper respiratory tract infection	Poisoning Acute intoxication Addiction Opioid related Overdose Poisoning by non-pharmaceuticals Stimulant related Withdrawal
Neuro Cerebral Hemorrhage/Stroke Encephalitis Encephalopathy Meningitis Neuro neoplasm Paralysis	Symptom/Sign Pain	Endocrine disorder Adrenal Insufficiency Diabetes Endocrine neoplasm Metabolic/nutrition

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ICD10 Categories: ANCA-associated Vasculitis (AAV), Abdominal trauma, Abortion, Acute intoxication, Addiction, Adrenal Insufficiency, Adverse effect, Alcohol related, Allergy, Anemia, Anesthetic related, Aneurysm, Antibiotic resistance, Antidepressant related, Aortic Aneurysm, Arrhythmia, Arterial thromboembolism, Asthma, Atherosclerosis, Awaiting/delayed transfer, Bacteria, Benign neoplasm, Breast disease, Burn, COVID, Cannabis related, Cardiac septum problem, Cardiovascular, Cerebral Hemorrhage/Stroke, Chemical burn, Chronic kidney disease, Cirrhosis, Cocaine related, Decubitus ulcer, Delirium, Dementia, Diabetes, Diagnosis implying death, Double duty pathogen, ENT, Encephalitis, Encephalopathy, Endocrine disorder, Endocrine neoplasm, Exposure, Eye, Female genital neoplasm, Fistula, Fracture, Fungus, GI ulcer, Gastroenteritis, Gastrointestinal, Gastrointestinal neoplasm, Hallucinogen related, Has one, Head trauma, Head trauma (old), Healthcare contact, Heart valve disease, Heme/immunology, Heme/immunology neoplasm, Hemophilia, Hemorrhage, Hepatitis, Hereditary/congenital, Hernia, Hypertension, Hypotension, Iatrogenic, Iatrogenic infection, Iatrogenic mechanism, Imaging, Infection requiring pathogen, Infection with implied pathogen, Infectious disease, Inflammatory Bowel Disease, Influenza, Inhalation, Intra-abdominal infection, Ischemia, Ischemic gut, Ischemic heart disease, Joint/ligament trauma, Leukemia, Liver disease, Liver failure, Lower limb trauma, Lower respiratory tract infection, Lymphoma, Male genital neoplasm, Mechanism, Meningitis, Metabolic/nutrition, Metastasis, Misc, Muscle problem, Muscles/tendon trauma, Musculoskeletal/soft tissue, Musculoskeletal/soft tissue neoplasm... further results