Alphabetic Index FY2027

R65.20

Severe sepsis without septic shock

FY2027Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified/R50–R69 General symptoms and signs

BillableComplete code, valid to report
Care settingsHospice: not accepted as primaryHospital MCC

R65.20 (also written R6520) is a billable ICD-10-CM diagnosis code for severe sepsis without septic shock. It is part of the FY2027 code set, effective October 1, 2026. It is one of the 4 codes in category R65 (Symptoms and signs specifically associated with systemic inflammation and infection). The Alphabetic Index lists it under 4 entries. Its coding notes include a Code first instruction, a Use additional code instruction and 4 Excludes2 entries.

Guidelines tips

From the FY2027 Official Guidelines. ICD10Ref adds no rules of its own.

Sepsis is coded to the underlying systemic infection, with A41.9 as the default. Urosepsis has no default code and the provider must be queried. R65.2 needs documented severe sepsis or associated organ dysfunction.

Guidelines I.C.1.d.1.aSepsis, severe sepsis and urosepsisRead the official text

Symptom and sign codes are acceptable when no definitive diagnosis has been established. They are not added for signs that are routinely associated with a diagnosis.

Guidelines I.C.18.a; I.C.18.bSymptom and sign codesRead the official text

Code first

If the underlying condition listed here is present and known, sequence it first.

Inherited from R65.2 Severe sepsis
  • underlying infection, such as:
    • infection following a procedure (T81.4-)
    • infections following infusion, transfusion and therapeutic injection (T80.2-)
    • puerperal sepsis (O85)
    • sepsis following complete or unspecified spontaneous abortion (O03.87)
    • sepsis following ectopic and molar pregnancy (O08.82)
    • sepsis following incomplete spontaneous abortion (O03.37)
    • sepsis following (induced) termination of pregnancy (O04.87)
    • sepsis NOS (A41.9)

Use additional code

Add the listed code as a secondary code, if known.

Inherited from R65.2 Severe sepsis
  • code to identify specific acute organ dysfunction, such as:
    • acute kidney failure (N17.-)
    • acute respiratory failure (J96.0-)
    • critical illness myopathy (G72.81)
    • critical illness polyneuropathy (G62.81)
    • disseminated intravascular coagulopathy [DIC] (D65)
    • encephalopathy (metabolic) (septic) (G93.41)
    • hepatic failure (K72.0-)

Excludes2

Not included here. Both codes may be reported if the patient has both conditions.

Also from chapter/block level (4 notes)
Inherited from Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
  • abnormal findings on antenatal screening of mother (O28.-)
  • certain conditions originating in the perinatal period (P04-P96)
  • signs and symptoms classified in the body system chapters
  • signs and symptoms of breast (N63, N64.5)

Care settings

How CMS programs treat this code. These are CMS claim edits and list entries, not coverage or eligibility rules.

Hospice: not accepted as primary

Not accepted as the principal diagnosis on a hospice claim (bill types 081x and 082x). The Integrated OCE returns an edit for this code.
Reason: Supplementary or additional code, not allowed as principal diagnosis.

Source: CMS Integrated Outpatient Code Editor (IOCE) v27.3, effective October 1, 2026, edit 113

Hospital MCC

Counts as a major complication or comorbidity (MCC) when reported as a secondary diagnosis on an inpatient claim. It does not count when the principal diagnosis is one of the 46 codes in its exclusion list. Some MS-DRGs also ignore a CC or MCC that defines the DRG.

Source: CMS MS-DRG Definitions Manual v44, effective October 1, 2026, Appendix C

Inclusion terms

Conditions classified to this code.

This code
  • Severe sepsis NOS

Notes

Also from chapter/block level (9 notes)
Inherited from Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
  • This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
  • Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
  • The conditions and signs or symptoms included in categories R00-R94 consist of:
    • (a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
    • (b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
    • (c) provisional diagnosis in a patient who failed to return for further investigation or care;
    • (d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
    • (e) cases in which a more precise diagnosis was not available for any other reason;
    • (f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.

Alphabetic Index terms

Terms the official Alphabetic Index lists for this code. 4 entries