W16.1 — Fall into natural body of water
W16.1 is a non-billable header ICD-10-CM code for fall into natural body of water. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.
This code requires a 7th character
The appropriate 7th character is to be added to each code from category W16
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Fall into lake
- Fall into open sea
- Fall into river
- Fall into stream
Other codes that can never be billed with W16.1
These codes carry an Excludes1 note pointing at W16.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading W16.1 alone.
- W69Accidental drowning and submersion while in natural water
- W69.XXXAAccidental drowning and submersion while in natural water, initial encounter
- W69.XXXDAccidental drowning and submersion while in natural water, subsequent encounter
- W69.XXXSAccidental drowning and submersion while in natural water, sequela
Risk adjustment
W16.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Code to one of these instead W16.1
3 child codes. Green means billable.
Related codes at this level
Codes that share W16. If W16.1 is not quite right, the correct code is usually one of these.
- W16.0Fall into swimming pool
- W16.2Fall in (into) filled bathtub or bucket of water
- W16.3Fall into other water
- W16.4Fall into unspecified water
- W16.5Jumping or diving into swimming pool
- W16.6Jumping or diving into natural body of water
- W16.7Jumping or diving from boat
- W16.8Jumping or diving into other water
- W16.9Jumping or diving into unspecified water
Questions about W16.1
- Is W16.1 a billable ICD-10-CM code?
- No. W16.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does W16.1 sit in the tabular list?
- External causes of morbidity (V00-Y99), in the block Slipping, tripping, stumbling and falls (W00-W19).