Is ICD-10-CM code W16 billable?

No, W16 (Fall, jump or diving into water) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code W16 belong to?

W16 belongs to Chapter 20 of the ICD-10-CM tabular list: V00–Y99 (External Causes of Morbidity).

W16Not billable, use a more specific code below

Fall, jump or diving into water

In Slipping, tripping, stumbling and falls (W00-W19), chapter 20: External Causes of Morbidity

138 billable codes under W16: none are a CC or MCC; none map to an HCC.

Instructional notes

Excludes1: not coded here, use a different code

accidental non-watercraft drowning and submersion not involving fall (W65-W74)
effects of air pressure from diving (W94.-)
fall into water from watercraft (V90-V94)
hitting an object or against bottom when falling from watercraft (V94.0)

Excludes2: not included here, code separately if applicable

striking or hitting diving board (W21.4)

Also applies, from Slipping, tripping, stumbling and falls (W00-W19)

These notes sit on W00-W19 and apply to every code under it, including W16.

Excludes1: not coded here, use a different code

assault involving a fall (Y01-Y02)
fall from animal (V80.-)
fall (in) (from) machinery (in operation) (W28-W31)
fall (in) (from) transport vehicle (V01-V99)
intentional self-harm involving a fall (X80-X81)

Excludes2: not included here, code separately if applicable

at risk for fall (history of fall) Z91.81
fall (in) (from) burning building (X00.-)
fall into fire (X00-X04, X08)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers how to report external cause codes (V00-Y99) describing cause, intent, place, activity, and status. They are never principal or first-listed, and reporting is voluntary unless required.

General External Cause Coding Guidelines (page 88)
Place of Occurrence Guideline (page 89)
Activity Code (page 89)
Place of Occurrence, Activity, and Status Codes Used with other External Cause Code (page 89)
If the Reporting Format Limits the Number of External Cause Codes (page 90)
Multiple External Cause Coding Guidelines (page 90)
Child and Adult Abuse Guideline (page 90)
Unknown or Undetermined Intent Guideline (page 91)

Read Section I.C.20 (page 87), 3 more topics

All codes under W16

W16 can't be used on a claim. Pick a billable code below; grey headings group them.

W16 MS-DRGs

This code does not group to an MS-DRG as a principal diagnosis.

Other codes that refer to W16

Notes on these codes point to W16.

V90 Excludes1: fall into water not from watercraft (W16.-)
V92 Excludes1: fall into water without watercraft (W16.-)
W21.4 Use Additional Code: code for subsequent falling into water, if applicable (W16.-)
W65-W74 Excludes1: accidental drowning and submersion due to fall into water (W16.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Falls

Falls can be dangerous at any age. Babies and young children can get hurt falling off furniture or down the stairs. Older children may fall off playground equipment. For older adults, falls can be especially serious. They are at higher risk of falling. They are also more likely to fracture (break) a bone when they fall, especially if they have osteoporosis. A broken bone, especially when it is in a hip, may even lead to disability and a loss of independence for older adults.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.