ICD-10 W16.0
Non-Billable HeaderFall into swimming pool
About ICD-10-CM W16.0
ICD-10-CM code W16.0 represents Fall into swimming pool. This is a non-billable header code in the External Causes of Morbidity chapter (block W16). The 2026 edition of ICD-10-CM W16.0 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under W16.0. Per CMS ICD-10-CM Tabular 2026.
- Fall into swimming pool NOS
Type 1 Excludes
Pure excludes, these codes can never be coded together with W16.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- fall into empty swimming pool (W17.3)
Medicare LCD Coverage for W16.0
Local Coverage Determinations (LCDs) from CMS MACs that list W16.0 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 W16.0.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but W16.0 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with W16.0
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 W16.0
Other codes in section W00-W19 (Slipping, tripping, stumbling and falls).
ICD-10 W16.0, Billing FAQ
Is ICD-10 code W16.0 billable? +
No, W16.0 is a non-billable header code. Use a more specific child code from block W16 when submitting claims.
What other names or terms map to W16.0? +
ICD-10 W16.0 includes: Fall into swimming pool NOS.
What codes are Type 1 Excludes for W16.0? +
Type 1 Excludes (never code together with W16.0): fall into empty swimming pool (W17.3)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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