Non-Infectious SIRS: Documentation and Coding Considerations

Non-infectious SIRS (systemic inflammatory response syndrome) with or without organ dysfunction is an inflammatory response not due to infection.

Clinical Indicators of Non-Infectious SIRS

Two or more of the following:

• Temp >38°C (100.4°F) or <36°C (96.8°F)
• WBC >12,000/microL or <4,000/microL or Bands >10%
• Heart Rate >90 beats/min
• Respiratory rate >20 breaths/min 

Common Conditions Associated With Non-Infectious SIRS

Non-infectious SIRS seen in patients with pancreatitis, acute mesenteric ischemia, burns, major surgical procedures, advanced malignancies, major traumas, tumor lysis syndrome, myocardial infarction and transfusion reactions.

ICD-10-CM Coding for Non-Infectious SIRS

Codes are given based on whether acute organ dysfunction is present:

• R65.10, SIRS of noninfectious origin without acute organ dysfunction (CC)
• R65.11, SIRS of noninfectious origin with acute organ dysfunction (MCC)
• Per the Excludes 1 note, SIRS is not reported if sepsis is present
• If documentation is not clear concerning whether SIRS is related to acute organ dysfunction, the provider should be queried

Acute Organ Dysfunction Considerations

Possible acute organ dysfunction includes but is not limited to: acute respiratory failure, AKI, acute metabolic encephalopathy, critical illness myopathy, and disseminated intravascular coagulation (DIC).

CDI Query Prompt for SIRS Clarification

Can you please specify if you are treating and/or monitoring any of the following conditions?

• Noninfectious SIRS with acute organ dysfunction
• Noninfectious SIRS without acute organ dysfunction
• Other, please specify

Clinical Indicators:

Admitted for acute pancreatitis

VS: HR 100–122, RR 22–30, WBCs on admit 18K, Temp 101.2

Blood/Urine cultures negative

Treatments include pain medication and IV fluids



Alyce Reavis, RN,MSN,CCDS,CCS 

Senior CDI Educator, Consulting Services at UASI

Drawing on clinical experience in adult, pediatric, and neonatal acute care, Alyce brings valuable insight to CDI education and documentation improvement. She holds an MSN in Leadership/Education along with CCDS, CCS, and AHIMA’s outpatient CDI micro credential, supporting health systems in strengthening documentation accuracy, quality reporting, and reimbursement integrity. Passionate about truthful, clinically aligned health records, she helps organizations ensure documentation reflects true patient acuity. She is a past presenter



Works Cited

Centers for Medicare & Medicaid Services. (2025). ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026.
Available at https://www.cms.gov/files/document/fy-2026-icd-10-cm-coding-guidelines.pdf

American Hospital Association. (n.d.). Systemic inflammatory response syndrome (SIRS) and organ dysfunction. Coding Clinic for ICD-10-CM/PCS. Available at https://www.ahacentraloffice.org/aha-coding-clinic