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.
• Do not code this if the patient qualifies as having Shock, septic.
• 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
GCS	15	13-14	10-12	6-9	<6
Platelets	>=150	<150	<100	<50	<20
Serum bilirubin (uM)	<20	20-32	33-101	102-204	>204
Serum creatinine (uM)	<110	110-170	171-299	300-440	>440
Urine output (mL/day)				<500	<200
PaO2/FIO2	>=400	<400	<300	<200	<100
Cardiovascular	MAP>=70	MAP<70	see note A	see note B	see note C

• 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

• Sepsis (SIRS due to infection, without acute organ failure)
• Shock, septic
• Puerperal (post-delivery) infections or sepsis
• 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 CCI Codes

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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