ICD-10 W16
Non-Billable HeaderFall, jump or diving into water
About ICD-10-CM W16
ICD-10-CM code W16 represents Fall, jump or diving into water. This is a non-billable header code in the External Causes of Morbidity chapter (block W16). The 2026 edition of ICD-10-CM W16 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with W16. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- 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)
Type 2 Excludes
Not included here, the excluded code is not part of W16, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- striking or hitting diving board (W21.4)
Coding Notes
Seven Chr Note
- The appropriate 7th character is to be added to each code from category W16
Medicare LCD Coverage for W16
Local Coverage Determinations (LCDs) from CMS MACs that list W16 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing W16.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but W16 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with W16
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To W16
Other codes in section W00-W19 (Slipping, tripping, stumbling and falls).
ICD-10 W16, Billing FAQ
Is ICD-10 code W16 billable? +
No, W16 is a non-billable header code. Use a more specific child code from block W16 when submitting claims.
What codes are Type 1 Excludes for W16? +
Type 1 Excludes (never code together with W16): 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)
What codes are Type 2 Excludes for W16? +
Type 2 Excludes (may be coded together when both conditions exist): striking or hitting diving board (W21.4)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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