October 1 update. Our PDGM and ICD-10 tools now use the FY2027 code set: 190 codes added, 30 deleted, and no existing code changed clinical group.

See what changed

ICD-10 · PDGM grouping

R65 Symptoms and signs specifically associated with systemic inflammation and infection

All 4 codes in the R65 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Codes in family

4

Can lead a claim

0

Cannot lead a claim

4

What CMS assigns to R65

None of the 4 codes is assigned a clinical group. None of the 4 is assigned a comorbidity subgroup. None can lead a claim. CMS attaches a code-first note to all 4.

Code first

CMS grouper convention 161, on R65.10, R65.11. Code first:

  • heatstroke (T67.0-)
  • injury and trauma (S00-T88)
  • underlying condition, such as:

CMS grouper convention 162, on R65.20, R65.21. Code first:

  • infection following a procedure (T81.4-)
  • infections following infusion, transfusion and therapeutic injection (T80.2-)
  • puerperal sepsis (O85)
  • sepsis NOS (A41.9)
  • sepsis following (induced) termination of pregnancy (O04.87)
  • sepsis following complete or unspecified spontaneous abortion (O03.87)
  • sepsis following ectopic and molar pregnancy (O08.82)
  • sepsis following incomplete spontaneous abortion (O03.37)
  • underlying infection, such as:

Every code in R65

Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.

CodeDescriptionPrimary positionClinical groupComorbidity subgroup
R65.1 Systemic inflammatory response syndrome (SIRS) of non-infectious origin
R65.10Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunctionCMS: SIRS of non-infectious origin w/o acute organ dysfunctionCannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosisNoneNone
R65.11Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunctionCMS: SIRS of non-infectious origin w acute organ dysfunctionCannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosisNoneNone
R65.2 Severe sepsis
R65.20Severe sepsis without septic shockCannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosisNoneNone
R65.21Severe sepsis with septic shockCannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosisNoneNone

Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.

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